CLINICOPATHOLOGICAL EVIDENCE THAT NEOVASCULARIZATION IS A CAUSE OF RECURRENT VARICOSE-VEINS

Objectives: Recurrent varicose veins may result from poor initial surg ical technique or progression of varicosities in collateral veins. In some cases new veins may develop at the saphenofemoral junction (neova scularisation) and cause recurrent saphenofemoral incompetence. This w as a histological study of recurrent varicose veins. Design: This clin icopathological study included 20 patients (median age 55 years) who h ad surgery for recurrent saphenofemoral incompetence. Materials and me thods: A total of 28 legs had groin re-exploration with repeat flush s aphenofemoral ligation. The venous tissue block from the saphenofemora l region (including the proximal thigh varicosity) was excised and ori entated for histological analysis. Evidence of neovascularisation was sought using routine histological sections and S100 immunohistochemist ry. Results: At operation, thin-walled, serpentine neovascular veins w ere detected clinically as the principal cause of recurrence at 19 gro ins. In five groins recurrence was due to a residual missed vein at th e saphenofemoral junction, and in four recurrence was caused by cross groin collaterals. On histological sections, evidence of neovascularis ation was present in 27 of 28 groins. In eight it co-existed with the veins missed at the original operation but it was the sole identified cause of recurrent saphenofemoral incompetence in 19 (68%) groins. Con clusions: Neovascularisation was the principal cause of recurrent saph enofemoral incompetence in this series.