Treatment of recurrent saphenofemoral incompetence: surgical approach still up-to-date?

Abstract

Introduction Recurrent varicose veins are a common medical problem despite the development of new operation techniques and a variety of minimal invasive treatments. The ideal treatment of recurrent saphenofemoral incompetence is still matter of debate. Nowadays, the open inguinal reoperation seems to fade into the background because of available less invasive treatment alternatives.

Methods This review article is based on current guidelines and a systematic PubMed search of article references dealing with the use and effectiveness of various techniques for the treatment of recurrent saphenofemoral incompetence. Besides this main topic, we highlight the causes, classification and frequency of recurrence after varicose vein treatment.

Results Recurrence of varicose veins after surgical or endovenous treatment for great saphenous vein incompetence is a frequent event. Causes for same site recurrence are neovascularization, especially after surgical treatment, and recanalization or reflux into groin tributaries after endovenous ablation leaving a saphenofemoral stump, as well as tactical and technical errors. Disease progression is leading to different site recurrence. Clinically relevant saphenofemoral recurrence can be treated by inguinal reoperation or ultrasound guided foam sclerotherapy without any anatomical restrictions. However, inguinal reoperation particularly when providing a barrier technique seems to be more effective than sclerotherapy in the long-term and is connected with a high patients’ satisfaction in spite of its invasiveness. Endovenous ablation is likewise effective but limited to the treatment of persistent saphenous or accessory trunks. In many cases the combination of surgical or endovenous treatment with foam sclerotherapy is a feasible approach.

Conclusion Due to its long-term efficacy the surgical approach with inguinal reoperation for recurrent saphenofemoral incompetence is indeed still up-to-date. Randomized studies comparing surgery, endovenous ablation and foam sclerotherapy are needed to find out, if the potentially lower recurrence rates of the surgical approach outweigh the lower invasiveness with a need for repeated treatment sessions in case of sclerotherapy.

Key words

Endothermal ablation - inguinal reoperation - recurrent varicose veins - sclerotherapy

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