Hua Wang Rui, Yi Meng Qing, Jun Wu Xue, Xing Jin, Xuan Liu Zhao, Bo Li
Department of Vascular Surgery, Shandong Provincial Hospital, Shandong University, Shandong Province, China Department of Vascular Surgery, Jinan Central Hospital, Shandong University, Shandong Province, China.
Department of Vascular Surgery, Jinan Central Hospital, Shandong University, Shandong Province, China.
Vascular. 2014 Aug;22(4):267-73. doi: 10.1177/1708538113484023. Epub 2013 Jun 24.
The purpose of this study was to explore the causes of recurrent lower limb varicose veins after surgical interventions.
A retrospective five-year survey was conducted on patients who underwent second surgery due to recurrent lower limb varicose veins after surgical interventions. A total of 141 limbs (112 cases), including 72 cases of left lower limbs, 47 of right lower limbs and 22 of both limbs, were involved in the study. All patients underwent lower limb venography (141 limbs were anterograde and 28 cases were retrograde), and then examined with color-Doppler ultrasound.
The major causes that urged patients to undergo second surgery are clinical changes graded above CEAP IV (93.6%), limb edema without changes on skin (5%), and single varicosity (1.4%). Up to 127 (83%) limbs exhibited perforating venous reflux, 67 (47.5%) limbs had varied degrees of deep venous insufficiency and 68 (48.2%) limbs had through or above-the-knee great saphenous vein trunk residual.
Preoperative venography before operation is indispensible in confirming the diagnosis and operation strategies. Patients with severe primary deep venous reflux and symptoms up to C3 may need simultaneous repair of the deep venous valves.
本研究旨在探讨手术干预后下肢静脉曲张复发的原因。
对因手术干预后下肢静脉曲张复发而接受二次手术的患者进行了为期五年的回顾性调查。共有141条肢体（112例）纳入研究，其中左下肢72例，右下肢47例，双下肢22例。所有患者均接受下肢静脉造影（141条肢体为顺行造影，28例为逆行造影），然后进行彩色多普勒超声检查。
促使患者接受二次手术的主要原因是临床分级高于CEAP IV级的变化（93.6%）、皮肤无变化的肢体水肿（5%）和单一静脉曲张（1.4%）。多达127条肢体（83%）出现交通静脉反流，67条肢体（47.5%）有不同程度的深静脉功能不全，68条肢体（48.2%）有膝上或膝部大隐静脉主干残留。
术前静脉造影对于确诊和制定手术策略必不可少。原发性深静脉反流严重且症状达C3级的患者可能需要同时修复深静脉瓣膜。
