Neovascularisation is the principal cause of varicose vein recurrence: Results of a randomised trial of stripping the long saphenous vein

Objectives: To determine whether routine stripping of the long saphenous vein reduces recurrence after varicose vein surgery. Design: Randomised controlled trial. All operations done by a consultant vascular surgeon. Two year follow-up. Materials and methods: One hundred patients with primary long saphenous varicose veins (133 legs) were randomised. Two year follow-up in 81 patients (113 legs) with questionnaire, clinical examination and Duplex scanning. Results: Some 89% remained satisfied with the results of their surgery, though 35% had recurrent veins on clinical examination Recurrence was reduced from 43 to 25% in patients who had their long saphenous vein stripped (p = 0.04, chi(2)). Neovascularisation (serpentine tributaries arising from the ligated saphenofemoral junction) was detected in 52% of limbs and was the commonest cause of recurrence. Most tributaries were less than 3 mm in diameter and only caused recurrence if the long saphenous vein or a major thigh vein was intact. Twelve patients had tributaries greater than 3 mm diameter and all had recurrent varicose veins. Conclusions: Recurrence is common after varicose vein surgery and in this study was caused principally by neovascularisation at the ligated saphenofemoral junction. Clinical recurrence is reduce by routine stripping of the long saphenous vein.