Late recurrent saphenofemoral junction reflux after ligation and strippingof the greater saphenous vein

Objective: This study was done to determine the long-term incidence of refl uxing epifascial-to-deep vein reconnections in the area of the former saphe nofemoral junction after Ligation of the true junction, along with all prox imal tributaries, and resection of the greater saphenous vein. Patients and Methods: A total of 125 limbs in 77 patients, representing 66% of 117 survivors among 602 patients who underwent operation between 1960 a nd 1967, were evaluated clinically and with duplex sonography for possible superficial-to-deep vein reconnections and clinical recurrence of thigh var icosities at a mean follow-up of 34 years. Results: Clinical examination suggested saphenofemoral recurrence in 59 lim bs (47%). In 11 instances these were actually varices associated with isola ted superficial system reflux or reflux originating from a distally located perforating vein. Color-coded duplex ultrasonography demonstrated saphenof emoral reflux in 75 limbs (60%), versus the 48 identified on clinical exami nation (P<.001), and documented that the junction ligation had not been per formed incorrectly by absence of the terminal valve or any patent proximal saphenous remnant. The reflux originated at the site of the Ligated sapheno femoral junction in 53 limbs (71%) and from a nearby circumjunctional deep vein in the other 22 (29%). Of the real junctional recurrences, 22 appeared as a tangled cluster, and 31 involved a single-lumen varix. Only 27 recurr ences were sufficiently symptomatic to warrant consideration of additional treatment; 25 of these were clinically evident, single-lumen, true junction al recurrences. Conclusions. This 34-year clinical follow-up study shows a 60% incidence of junctional and circumjunctional reconnections after ligation of the true s aphenofemoral junction and its related tributaries. Color-coded duplex sono graphy is a necessary concomitant to clinical examination, detecting more r ecurrences and defining the pathologic anatomy to direct clinically indicat ed additional treatments.