Nyamekye I, Shephard N A, Davies B, Heather B P, Earnshaw J J
Gloucestershire Vascular Group, Gloucestershire Royal Hospital, Gloucester, U.K.
Eur J Vasc Endovasc Surg. 1998 May;15(5):412-5. doi: 10.1016/s1078-5884(98)80202-5.
Recurrent varicose veins may result from poor initial surgical technique or progression of varicosities in collateral veins. In some cases new veins may develop at the saphenofemoral junction (neovascularisation) and cause recurrent saphenofemoral incompetence. This was a histological study of recurrent varicose veins.
This clinicopathological study included 20 patients (median age 55 years) who had surgery for recurrent saphenofemoral incompetence.
A total of 28 legs had groin re-exploration with repeat flush saphenofemoral ligation. The venous tissue block from the saphenofemoral region (including the proximal thigh varicosity) was excised and orientated for histological analysis. Evidence of neovascularisation was sought using routine histological sections and S100 immunohistochemistry.
At operation, thin-walled, serpentine neovascular veins were detected clinically as the principal cause of recurrence in 19 groins. In five groins recurrence was due to a residual missed vein at the saphenofemoral junction, and in four recurrence was caused by cross groin collaterals. On histological sections, evidence of neovascularisation was present in 27 of 28 groins. In eight it co-existed with the veins missed at the original operation but it was the sole identified cause of recurrent saphenofemoral incompetence in 19 (68%) groins.
Neovascularisation was the principal cause of recurrent saphenofemoral incompetence in this series.
复发性静脉曲张可能是由于初始手术技术欠佳或侧支静脉中静脉曲张进展所致。在某些情况下，新的静脉可能在隐股交界处形成（新生血管形成），并导致复发性隐股静脉功能不全。这是一项关于复发性静脉曲张的组织学研究。
这项临床病理研究纳入了20例（中位年龄55岁）因复发性隐股静脉功能不全接受手术的患者。
对总共28条腿进行腹股沟再次探查，并重复进行隐股静脉冲洗结扎术。切除隐股区域的静脉组织块（包括大腿近端静脉曲张），并进行定向以进行组织学分析。使用常规组织切片和S100免疫组织化学寻找新生血管形成的证据。
手术时，临床上检测到薄壁、蜿蜒的新生血管静脉是19个腹股沟复发的主要原因。在5个腹股沟中，复发是由于隐股交界处残留的遗漏静脉，在4个腹股沟中，复发是由交叉腹股沟侧支引起的。在组织切片上，28个腹股沟中有27个存在新生血管形成的证据。在8个病例中，它与初次手术时遗漏的静脉并存，但在19个（68%）腹股沟中，它是复发性隐股静脉功能不全唯一确定的原因。
在本系列中，新生血管形成是复发性隐股静脉功能不全的主要原因。
