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Changes in superficial and perforating vein reflux after varicose vein surgery
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
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2005 (English)In: Journal of Vascular Surgery, ISSN 0741-5214, Vol. 42, no 2, 315-320 p.Article in journal (Refereed) Published
Abstract [en]


This prospective duplex study was conducted to study the effect of current surgical treatment for primary varicose veins on the development of venous insufficiency < or = 2 years after varicose vein surgery.


The patients were part of a randomized controlled study where surgery for primary varicose veins was planned from a clinical examination alone or with the addition of preoperative duplex scanning. Postoperative duplex scanning was done at 2 months and 2 years.


Operations were done on 293 patients (343 legs), 74% of whom were women. The mean age was 47 years. In 126 legs, duplex scanning was done preoperatively, at 2 months and 2 years, and at 2 months and 2 years in 251 legs. Preoperative perforating vein incompetence (PVI) was present in 64 of 126 legs. Perforator ligation was not done on 42 of these; at 2 months, 23 of these legs (55%) had no PVI, and at 2 years, 25 legs (60%) had no PVI. Sixty-one legs had no PVI preoperatively, 5 (8%) had PVI at 2 months, and 11 (18%) had PVI at 2 years. In the group of 251 legs, reversal of PVI between 2 months and 2 years was found in 28 (41%) of 68 and was more common than new PVI, which occurred in 41 (22%) of 183 (P = .003). After 2 years, the number of legs without venous incompetence in which perforator surgery was not performed was 11 (26%) of 42 legs with preoperative PVI and 18 (30%) of 61 legs without preoperative PVI, (P = .713). After 2 years, new vessel formation was more common in the surgically obliterated saphenopopliteal junction (SPJ), 4 (40%) of 10, than in the saphenofemoral junction (SFJ), 17 (11%) of 151(P = .027), and new incompetence in a previously normal junction was more common in the SFJ, 11 (18%) of 63, than in the SPJ, 3 (1%) of 226 (P < .001). Reflux in the great saphenous vein (GSV) below the knee was abolished after stripping above the knee in 17 (34%) of 50 legs at 2 months and in 22 legs (44%) after 2 years.


Varicose vein surgery induces changes in the remaining venous segments of the legs that continue for several months. In most patients, perforators and the GSV below the knee can be ignored at the primary surgery. A substantial number of recurrences in the SFJ and SPJ are unavoidable with present surgical knowledge because they stem from new vessel formation and progression of disease.

Place, publisher, year, edition, pages
2005. Vol. 42, no 2, 315-320 p.
Keyword [en]
Female, Humans, Male, Middle Aged, Postoperative Period, Prospective Studies, Randomized Controlled Trials, Recurrence, Research Support; Non-U.S. Gov't, Saphenous Vein/ultrasonography, Ultrasonography; Doppler; Duplex, Varicose Veins/*physiopathology/*surgery/ultrasonography, Venous Insufficiency/*prevention & control
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-93235DOI: 10.1016/j.jvs.2005.03.043PubMedID: 16102633OAI: oai:DiVA.org:uu-93235DiVA: diva2:166651
Available from: 2005-05-23 Created: 2005-05-23 Last updated: 2013-03-21Bibliographically approved
In thesis
1. Varicose Veins: Aspects on Diagnosis and Surgical Treatment
Open this publication in new window or tab >>Varicose Veins: Aspects on Diagnosis and Surgical Treatment
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Treatment for varicose veins (VV) is insufficiently evidence based and recurrence rates are high. The aim of this thesis was to study the long-term results after VV surgery, risk factors for recurrences and the effect of preoperative duplex scanning on recurrence rate, quality of life (QoL) and costs.

In a follow-up study 89 patients with 100 legs operated on for VV 6–10 years earlier were re-examined with duplex, in 13 cases also with varicography. 57% had incompetent vessels in the groin visible with duplex, equally well defined by varicography. Residual branches could not be differentiated from new vessel formation. The recurrence rate did not correlate to the surgeon’s level of experience or perioperative difficulties at primary surgery.

In a prospective randomized study 293 patients (343 legs) were operated on for primary VV with or without preoperative duplex. Duplex was done postoperatively, at 2 months and 2 years. QoL was measured with SF-36 preoperatively, at 1 month, 1 year and 2 years.

After 2 years the number of reoperations were 2 in the group with preoperative duplex and 14 in the group without (p=0.002). Incompetent veins were seen in the saphenofemoral or saphenopopliteal junction in 19 and 53 legs respectively (p<0.001).

Preoperative QoL was worse in the VV patients compared to a reference population, and was normalised 2 years postoperatively. The improved surgical result in the duplex group was not reflected in a significantly higher QoL.

The lower costs for redo surgery in the duplex group did not offset the costs for duplex, partly due to more extensive primary surgery.

A significant proportion of recurrences after 2 years was new vessel formation and progression of disease. Preoperative perforating vein incompetence did not influence recurrence rate, and was abolished without specific interruption in 60% at 2 years postoperatively.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 71 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 53
Surgery, Varicose veins, Venous insufficiency, Surgery, Duplex, Quality of life, Cost analysis, Kirurgi
National Category
urn:nbn:se:uu:diva-5855 (URN)91-554-6290-1 (ISBN)
Public defence
2005-09-07, Hörsalen, St Görans Sjukhus, St Görans plan 1, Stockholm, 09:00
Available from: 2005-05-23 Created: 2005-05-23Bibliographically approved

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