Duplex scanning for recurrent varicose veins

Background: Most studies of recurrent varicose veins have been based on the findings clinically, at operation, or on phlebography. Occasionally these findings have been compared with Doppler findings produced by hand-held continuous-wave Doppler. Duplex scanning is a more refined approach to the assessment of recurrent varicose veins. Methods: 202 patients (267 legs) have been examined consecutively for recurrent varicose veins between January 1990 and December 1995 at St George Vascular Laboratory. This was a retrospective study of some aspects and patterns of recurrence of varicose Veins in this group. Results: The ratio of female to male was 3:1. The mean age of the group was 52 years and mean time to recurrence was 13 years (1 year 95% CI). There were six patterns of recurrence accounting for 95.2% of legs. In descending order of frequency, these were: (i) the saphenofemoral junction and long saphenous vein were intact and incompetent (44.6%); (ii) an incompetent thigh perforator and long saphenous vein remained intact; there was no saphenofemoral junction (16.5%); (iii) the long saphenous vein remained intact and incompetent; there was no saphenofemoral junction (10.5%); (iv) there was an incompetent saphenofemoral junction only (9.74%); (v) there was an intact and incompetent saphenopopliteal junction alone (9.74%); and (vi) an isolated thigh perforator was incompetent, with no more proximal site of incompetence detected (4.12%). Incompetent calf perforator (69.2%) and gastrocnemius veins (9.3%) were frequently detected, but rarely existed in isolation (seven legs in total). Conclusions: Duplex scanning is an important recent adjunct to the management of recurrent varicose veins in order to define the 'pathway of incompetence'. The saphenofemoral junction and long saphenous vein remain the key to recurrence of varicose veins. Calf perforator and gastrocnemius vein incompetence are of secondary importance in recurrent varicose veins.