Zan S, Varetto G, Maselli M, Scovazzi P, Moniaci D, Lazzaro D
Unit of Vascular Surgery, Division of Vascular Surgery University of Turin, S. Giovanni Battista Hospital, Turin, Italy.
Minerva Cardioangiol. 2003 Feb;51(1):79-83, 83-6.
This paper analyses the causes and describes the best care of recurrent varicose veins after internal saphenectomy.
A series of 19 patients who had previously undergone internal saphenectomy were selected for surgery due to recurrent varices in the lower limbs. Clinical examination and colour duplex sonography were used as the preoperative diagnostic tools in all patients. No patients underwent phlebography. In 17 cases the main source of reflux was an incontinent saphenous stump at the level of the saphenofemoral junction with varicose cross-groin collaterals. In 2 cases recurrence was caused by incontinence of the upper thigh perforating vein. In 1 of these patients the recurrence also involved the district of the small saphenous vein. Groin neovascularisation was detected in 1 patient.
All patients underwent groin re-dissections using transversal incisions: in 9 cases, access to the saphenofemoral junction was obtained under or at the same level as the inguinal fold, and in 10 cases using a suprainguinal route. The vertical inguinal incision was never employed. Incompetent perforating veins (thigh or leg) were ligated or sectioned in 11 patients. Ligations and exeresis of communicating veins were executed in all patients. Müller's phlebectomies were performed intra- or postoperatively on collateral varices in practically all cases. Postoperative ambulatory sclerotherapy was necessary in 6 cases.
A correct surgical approach is only assured by diagnostic accuracy coupled with a precise hemodynamic evaluation. Correct management of the postoperative follow-up of varicose vein surgery is also important.
本文分析了大隐静脉高位结扎剥脱术后复发性静脉曲张的原因，并描述了最佳治疗方法。
选取19例曾接受大隐静脉高位结扎剥脱术的患者，因下肢静脉曲张复发而接受手术。所有患者术前均采用临床检查和彩色多普勒超声作为诊断工具。无患者接受静脉造影检查。17例患者反流的主要来源是大隐静脉股静脉交界处的大隐静脉残端失禁，伴有曲张的腹股沟交叉侧支。2例复发是由大腿上段穿通静脉失禁引起。其中1例患者的复发还累及小隐静脉区域。1例患者检测到腹股沟新生血管形成。
所有患者均采用横向切口进行腹股沟再次解剖：9例患者通过腹股沟皱襞下方或同一水平进入大隐静脉股静脉交界处，10例患者采用腹股沟上入路。从未采用垂直腹股沟切口。11例患者结扎或切断了功能不全的穿通静脉（大腿或小腿）。所有患者均进行了交通静脉结扎和切除术。几乎所有病例均在术中或术后对侧支静脉曲张进行了 Müller 静脉切除术。6例患者术后需要门诊硬化治疗。
只有通过诊断准确性和精确的血流动力学评估才能确保正确的手术方法。正确管理静脉曲张手术的术后随访也很重要。
