Causes of re-recurrence after polytetrafluoroethylene patch saphenoplasty for recurrent varicose veins

Background: The aim of this study was to determine whether a polytetrafluor oethylene (PTFE) patch sutured over the religated saphenofemoral junction c ould reduce the rate of recurrence after operation for recurrent varicose v eins. Methods: Fifty patients who had surgery for recurrent long saphenous incomp etence (81 legs) had a small PTFE patch sutured over the religated saphenof emoral junction. There were no major complications following surgery. Three patients had a wound infection or delayed healing. All patients were invit ed for clinical examination and duplex imaging at a median of 19 (range 6-3 9)months after operation. Results: Some 38 of 43 patients (70 legs) remained satisfied with the resul ts of surgery; 16 (23 per cent) of 70 legs had visible veins on inspection and eight of these (11 per cent) involved symptomatic recurrence. Duplex im aging showed that recurrence was due to saphenofemoral junction incompetenc e in ten legs; two appeared to have a major groin connection but the other eight appeared to have neovascularization. Other causes were thigh perforat or reflux (three legs) and cross-groin collaterals (three). Eleven of the 1 6 legs with recurrence had varicography but in two the procedure was a tech nical failure. Two legs had evidence of a significant connection (more than 3 mm) and two a minor connection (less than 3 mm) to the femoral vein at t he level of the PTFE patch, but in the remainder recurrence was due to uppe r thigh perforating veins. There was good concordance between duplex imagin g and varicography. Conclusion: PTFE patch saphenoplasty appears to be safe. Although these are early results, the technique seems potentially as effective as other barri er methods that have been investigated; in ten legs (12 per cent) recurrenc e was attributed to failure at the level of the PTFE patch.