DUPLEX ULTRASOUND SCANNING FOR CHRONIC VENOUS DISEASE - RECURRENT VARICOSE-VEINS IN THE THIGH AFTER SURGERY TO THE LONG SAPHENOUS-VEIN

Objective: To use duplex ultrasound scanning to compare limbs with rec urrent and primary varicose veins and to identify connections between deep veins and recurrences. Setting: A non-invasive vascular laborator y in Melbourne, Australia. Patients: A study of 779 limbs with recurre nt varicose veins previously treated by ligation or stripping of the l ong saphenous vein and 1521 limbs with primary varicose veins. Main ou tcome measures: Connections between deep veins and recurrent varices, reflux in superficial and deep veins, and outward how in perforators a s demonstrated by duplex ultrasonography. Results: Recurrence was due to reflux in the long saphenous territory in 71.8%, short saphenous re flux alone in 14.7% or outward flow in calf perforators without saphen ous reflux in 5.2%, while no source was detected in 8.3%. Limbs with r ecurrent veins in the long saphenous territory were compared with limb s with primary varicose veins; there was more frequent outward flow in thigh perforators (25.2% vs. 16.2%) but no difference for deep reflux (20.7% vs. 17.5%) or outward how in calf perforators (56.8% vs. 53.1% ). The source for recurrence in the long saphenous territory was from a single large connection in the groin in 46.3%, multiple smaller prox imal connections in a further 46.3%, or thigh perforators in 7.4%. The destination was to an intact long saphenous vein in 33.7%, major trib utaries in 28.7% or to other varices in 37.6%. Limbs known to have bee n treated by long saphenous ligation alone were compared with those kn own to be treated by long saphenous ligation and stripping; the source was more likely to be from a single large vein in the groin (60.3% vs . 39.9%) and the destination was more likely to be an intact long saph enous vein or major tributary (75.0% vs. 55.2%). Conclusions: Duplex u ltrasound scanning detected the source of recurrent varicose veins in over 90% of patients and demonstrated whether there were single large or multiple smaller connections in the veins affected, and this helps to select the most appropriate treatment. Recurrence after stripping t he long saphenous vein was more likely to be due to multiple small con nections passing to scattered varices and this may allow more simple t reatment by injection sclerotherapy rather than repeat surgery.