RECURRENT VARICOSE-VEINS - ASSESSMENT OF THE SAPHENOFEMORAL JUNCTION

Thirty-six consecutive unselected patients, who had apparently previou sly undergone saphenofemoral ligation for primary uncomplicated long s aphenous varicosities and who had then re-presented with recurrent thi gh varices emanating from the groin, underwent preoperative clinical a ssessment, hand-held Doppler and duplex ultrasonographic examination a nd varicography to establish the presence or absence of saphenofemoral incompetence as the cause of recurrence. All patients underwent reexp loration of the saphenofemoral junction (SFJ) via a lateral approach. Twenty-six patients had an intact SFJ (type I recurrence) and ten had varices arising from either a thigh perforator, or from abdominal or p erineal veins (type II recurrence). Clinical examination alone was poo r at distinguishing type I from type II recurrence. Doppler ultrasonog raphy was sensitive (88 per cent) but non-specific (40 per cent). In c ontrast, duplex scanning was insensitive (42 per cent) but extremely s pecific (100 per cent) and accurate, with a positive predictive value of 100 per cent. Varicography also had a specificity and positive pred ictive value of 100 per cent, a sensitivity of 73 per cent and in addi tion provided a precise anatomical 'road-map'. A combination of clinic al examination and hand-held Doppler ultrasonography seems to be the m ost appropriate first-line method of preoperative assessment in these patients. Duplex ultrasonography, if available, will provide additiona l useful information about both the SFJ and the presence of thigh perf orators. Contrast examination may be reserved for patients who have eq uivocal results on non-invasive investigations, who have had more than one previous groin operation or who have, in addition, deep venous di sease.