Neovascularization in recurrent sapheno-femoral incompetence of varicose veins: Surgical anatomy and morphology

Objective: To investigate the surgical anatomy and morphology of recurrent sapheno-femoral incompetence after correctly performed sapheno-femoral ligation. To test the hypothesis that such recurrence develops through neovascularization. Design: Prospective study of single patient group. Setting: Varicose vein clinic of teaching hospital. Patients: One hundred and twenty-eight patients (141 limbs) were reviewed 4 or more years after accurately performed sapheno-femoral ligation with catgut, silk or tantalum wire. Intervention: Clinical assessment, phlebography, surgical exploration and examination of recurrent veins by radiographic and histological methods. Main outcome measures: Presence of reflux through newly formed veins at the site of previous ligation. Results: Of 141 limbs, clinical or phlebographic evidence of sapheno-femoral recurrence was confirmed in 35 of 37 on surgical exploration. The continuity of the saphenous vein with the previously ligated saphenofemoral junction was restored through a newly formed vein or complex of veins. Conclusions: Neovascularization was the cause of recurrent sapheno-femoral incompetence after correctly performed sapheno-femoral ligation.