DIAGNOSTIC AND SURGICAL APPROACHES TO RECURRENT VARICOSE-VEINS OF LOWER-LIMBS

A consecutive series of 82 patients (98 legs) suffering from recurrent varicose veins underwent surgical treatment; In all patients clinical and hand-held US Doppler preoperative examinations were performed, bu t a phlebography was necessary in 33 legs to certainly visualize the a natomy of venous system and the potential sites of recurrent deep to s uperficial reflux, The causes of recurrence were: incompetent saphenof emoral junction in 59 legs, saphenopopliteal reflux in 6 legs, incompe tence of perforator veins in 18 legs, both insufficiencies of great sa phena and perforators in 15 legs, Seventy-four legs with saphenofemora l reflux underwent groin redissections through transversal (44 legs) o r vertical (30 legs) incisions; the approach to the saphenopopliteal j unction was vertical in two legs and transversal in four legs; the int erruption of incompetent perforator veins was performed through incisi ons in 29 legs and according to Linton's technique in 4 legs, Clinical and US Doppler follow-up was performed every 6 months and no recurren t reflux was demonstrated; seven patients were affected from new small varices that were treated by injection sclerotherapy, This study indi cates that more than 1/3 of recurrent varices need phlebography to be clearly studied: only diagnostic accuracy may assure a correct surgica l approach, but the strategy of treatment must be adapted to the singl e patient.