RECURRENT VARICOSE-VEINS - CORRELATION BETWEEN PREOPERATIVE CLINICAL AND HAND-HELD DOPPLER ULTRASONOGRAPHIC EXAMINATION, AND ANATOMICAL FINDINGS AT SURGERY

A consecutive series of 118 patients (148 legs) presenting with recurr ent varicose veins underwent preoperative clinical and hand-held Doppl er ultrasonographic examination by a single observer. The presence of saphenofemoral, mid-thigh perforator and saphenopopliteal reflux was n oted. Ultrasonography markedly improved the accuracy of clinical asses sment at all three potential sites of reflux compared with operative f indings. Of 71 patients undergoing repeat groin dissection, only 20 (2 8 per cent) had a tied saphenofemoral junction, 31 (44 per cent) had i ntact major tributaries and 52 (73 per cent) had an intact long saphen ous vein (LSV) in the thigh. There was a positive association between mid-thigh perforator reflux giving rise to recurrent varices and the p resence of an intact LSV in the thigh. Of 45 legs with saphenopoplitea l reflux, only four had previously undergone saphenopopliteal ligation , suggesting that most short saphenous varicosities had either appeare d after or had not been recognized at the time of primary surgery. Thi s study indicates that even an experienced vascular surgeon can have d ifficulty in assessing the presence or absence of recurrent deep to su perficial reflux by means of clinical examination alone and that Doppl er ultrasonographic examination is mandatory. Recurrence continues to be associated with persistent or recurrent incompetence at the site of previous inadequate surgery.