NEOVASCULARIZATION IS THE PRINCIPAL CAUSE OF VARICOSE-VEIN RECURRENCE- RESULTS OF A RANDOMIZED TRIAL OF STRIPPING THE LONG SAPHENOUS-VEIN

Objectives: To determine whether routine stripping of the long sapheno us vein reduces recurrence after varicose vein surgery. Design: Random ised controlled trial. All operations done by a consultant vascular su rgeon. Two year follow-up. Materials and methods: One hundred patients with primary long saphenous varicose veins (133 legs) were randomised . Two year follow-up in 81 patients (113 legs) with questionnaire, cli nical examination and Duplex scanning. Results: Some 89% remained sati sfied with the results of their surgery, though 35% had recurrent vein s on clinical examination Recurrence was reduced from 43 to 25% in pat ients who had their long saphenous vein stripped (p = 0.04, chi(2)). N eovascularisation (serpentine tributaries arising from the ligated sap henofemoral junction) was detected in 52% of limbs and was the commone st cause of recurrence. Most tributaries were less than 3 mm in diamet er and only caused recurrence if the long saphenous vein or a major th igh vein was intact. Twelve patients had tributaries greater than 3 mm diameter and all had recurrent varicose veins. Conclusions: Recurrenc e is common after varicose vein surgery and in this study was caused p rincipally by neovascularisation at the ligated saphenofemoral junctio n. Clinical recurrence is reduce by routine stripping of the long saph enous vein.