Duplex-derived evidence of reflux after varicose vein surgery: Neoreflux or neovascularisation?

Background: recurrent varicose veins remain a problem in surgical practice despite improvements to the preoperative investigation of, and surgery for varicose veins. Neovascularisation accounts for some cases of recurrence wi thin a few years of surgery, but other factors relating to disease progress ion must also play a part. We investigated whether new venous reflux (neore flux) could occur in the early postoperative period (within 6 weeks) follow ing successful varicose vein surgery. Methods: eighteen-month prospective observational study in the dedicated va scular surgery unit of a university teaching hospital. Forty-six patients, with primary saphenofemoral junction reflux, awaiting varicose vein surgery were chosen consecutively from the waiting list. All saphenofemoral surger y was performed in a standardised fashion. Assessments were performed prior to, at 6 weeks and at 1 year after surgery. Duplex ultrasound was used to identify and locate sites of reflux Results: neoreflux was present at the 6-week postoperative scan in nine lim bs after varicose vein surgery (19.6%), and resolved in 55.6% of patients w ithin 1 year. Neovascularisation was noted in two limbs at the 1-year scan. Conclusion: new sites of reflux, which may resolve spontaneously, occur in the early postoperative period despite adequate varicose vein surgery. It i s our hypothesis that this is a manifestation of the effect of altered veno us haemodynamics in a system of susceptible veins.