THE UNDERSTANDING OF THE POOR RESULTS AFT ER SURGICAL-TREATMENT OF SUPERFICIAL VENOUS INSUFFICIENCY

Effectiveness and value of surgical treatment in varicose veins remain s difficult to assess for many reasons. They are discussed in details in front of this general review devoted to poor results after varicose vein surgery. An other pathology is often associated with venous insu fficiency and is frequently missed and responsible of poor results. Ma ny factors contribute to make uneasy assessment of poor results. The l ack of objective criteria to appreciate the natural evolution of varic ose disease different from one patient to another. The difficulty to g rade clinical disease severity. Results published before the use of mo dern preoperative investigations make their report obsolete. Precise d ata of surgical treatment undertaken are often not detailed. The quali ty of therapists (surgeon or phlebologist) is uneasy to check. The dif ficulty to assess results after treatment: subjective results (patient ) vs objective results (audit). Duration of follow-up. Imprecise vocab ulary to qualify results. Clinical assessment remains the cornerstone but supplementary investigations must be undertaken. Duplex-Scan is cu rrently accepted as the gold standard investigation. Phlebography or ( and) plethysmography can be helpful in some cases. After detailed asse ssment patients can be classified in different groups. This classifica tion allows to determinate the most adequate treatment. In some select ed patients redosurgery is strongly recommended. Prevention of recurre nce after surgical treatment of varicose veins can not be complete. St rict respect of several rules can however reduce it. They can be summa rised as follows: Respect of temporary of definitive contraindications to surgical treatment. Thorough investigation before surgery. Preoper ative precise aim of what must be treated by the surgical procedure. C orrect operative procedure. Careful follow-up (minimum 5 years) after surgery including survey and complementary sclerotherapy (J Mal Vasc 1 994; 19: pages 265-271).