Egan Bridget, Donnelly Michael, Bresnihan Mary, Tierney Sean, Feeley Martin
Department of Vascular Surgery, The Adelaide and Meath Hospital incorporating the National Children's Hospital, Tallaght, Dublin, Ireland.
J Vasc Surg. 2006 Dec;44(6):1279-84; discussion 1284. doi: 10.1016/j.jvs.2006.08.017.
Varicose vein recurrence after surgery occurs in up to 60% of patients. A variety of technical factors have been implicated, but biological factors such as neovascularization have more recently been proposed. The objective of this study was to characterize the relative contribution of technical and biological factors to recurrence in a large prospective series of recurrent varicose veins.
Duplex and operative findings were recorded prospectively in a consecutive series of 500 limbs undergoing surgery for recurrent varicose veins between 1995 and 2005 in a university teaching hospital. Only limbs with previous saphenofemoral junction surgery were included. All limbs had preoperative duplex mapping by an accredited vascular technician who assessed the status of the great saphenous vein (GSV) in the thigh and groin, sought sonographic evidence of neovascularization, and reported on the presence of reflux in the short saphenous vein and perforator sites (typical and atypical). All operations were performed with an attending vascular surgeon as the lead operator.
Primary GSV surgery was incomplete in 83.2% of limbs. A completely intact GSV system was present in 17.4% of limbs. An incompetent thigh saphenous vein was present in 44.2% of limbs, 37.6% had GSV stump incompetence with one or more intact tributaries, and 16% had both a residual thigh GSV and an incompetent stump with intact tributaries. Non-GSV sites of reflux were identified in 25% of limbs. Neovascularization was identified on duplex scanning in 41 (8.2%) limbs. However, in 27 of these, surgical exploration revealed a residual GSV stump with 1 or more significant tributaries. Each of the remaining 14 (2.8%) limbs had a residual incompetent thigh GSV.
Despite reports to the contrary, neovascularization occurs in a relatively small proportion of patients with recurrent varicose veins. All recurrent varicose veins associated with duplex-diagnosed neovascularization are also associated with persistent reflux in the GSV stump tributaries, thigh GSV, or both. Recurrence after primary varicose vein surgery is associated with inadequate primary surgery or progression of disease, and neovascularization alone is not a cause of recurrent varicose veins.
手术治疗后静脉曲张复发率高达60%。多种技术因素与之相关，但诸如新生血管形成等生物学因素最近也被提及。本研究的目的是在一个大型前瞻性复发性静脉曲张系列研究中，明确技术因素和生物学因素对复发的相对影响。
1995年至2005年期间，在一所大学教学医院对连续500条接受复发性静脉曲张手术的肢体进行前瞻性双功超声和手术结果记录。仅纳入曾行大隐静脉股静脉交界处手术的肢体。所有肢体术前均由经认可的血管技术人员进行双功超声检查，评估大腿和腹股沟处大隐静脉（GSV）的状况，寻找新生血管形成的超声证据，并报告小隐静脉和穿通支部位（典型和非典型）有无反流。所有手术均由血管外科主治医生主刀。
83.2%的肢体初次GSV手术不完整。17.4%的肢体存在完全完整的GSV系统。44.2%的肢体大腿隐静脉功能不全，37.6%的肢体GSV残端功能不全且有一条或多条完整的属支，16%的肢体既有残留的大腿GSV又有功能不全的残端且有完整的属支。25%的肢体发现非GSV部位的反流。双功超声扫描发现41条（8.2%）肢体有新生血管形成。然而，其中27条经手术探查发现有残留的GSV残端且有1条或多条重要属支。其余14条（2.8%）肢体每条都有残留的功能不全的大腿GSV。
尽管有相反的报道，但新生血管形成在复发性静脉曲张患者中所占比例相对较小。所有与双功超声诊断的新生血管形成相关的复发性静脉曲张也与GSV残端属支、大腿GSV或两者持续反流相关。原发性静脉曲张手术后复发与初次手术不充分或疾病进展有关，单独的新生血管形成不是复发性静脉曲张的原因。
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