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Residual incompetent tributaries after varicose vein surgery increased the need for reintervention after 8 years
Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Cardiothoracic and Vascular Surgery.ORCID iD: 0000-0003-4222-6721
2020 (English)In: Journal of Vascular Surgery: Venous and Lymphatic Disorders, ISSN 1856-6847, E-ISSN 2213-3348Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: The aim of this study was to determine whether residual incompetent tributaries after varicose vein surgery affected the reintervention rate after longer follow-up.

METHODS: The study is a retrospective review of data from a cohort of a previous randomized controlled study comparing surgery with and without preoperative duplex ultrasound, with follow-up after 2 months, 2 years, and 5 to 9 years clinically and with duplex ultrasound. The cohort was subdivided according to the duplex ultrasound findings 2 months after surgery: no venous incompetence, residual incompetent tributaries only, truncal incompetence, and combined truncal and tributary incompetence. Reintervention rates were compared between groups.

RESULTS: There were 280 patients (326 legs) who attended follow-up 2 months postoperatively and 164 patients (190 legs) after a median of 8 years (5-9 years). Another 53 patients (62 legs) were interviewed by telephone or had been reoperated on earlier during follow-up; thus, information was available for 217 patients (252 legs). Of the 252 legs, 56 (22%) were reoperated on during follow-up. In the subgroup with no venous incompetence at all 2 months postoperatively, 4 of 74 legs (5%) were reoperated on; and in the group with residual incompetent tributaries without truncal incompetence, 16 of 56 legs (29%) were reoperated on (P = .000). There was no significant difference in reintervention rate of the group with incompetent tributaries only compared with those with truncal incompetence without incompetent tributaries (12/42 legs [29%]; P = 1) or with combined incompetence of truncal vein and tributaries (22/64 legs [34%]; P = .495). The presence of perforating vein incompetence at 2 months postoperatively did not significantly alter the rate of reoperations (P = .159). In legs that had not been reoperated on, more incompetent veins could be seen progressively. In the group without any incompetent veins postoperatively, 37% still had normal findings at 8 years.

CONCLUSIONS: Residual incompetent tributaries after treatment of varicose veins will increase the reintervention rate in the long term, as much as leaving a trunk vein untreated. Patients should be informed about the increased risk of reintervention if not all incompetent veins are targeted.

Place, publisher, year, edition, pages
Elsevier, 2020.
Keywords [en]
Recurrent varicose veins, Tributaries, Varicose vein surgery, Varicose veins
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-79733DOI: 10.1016/j.jvsv.2019.11.012PubMedID: 31992538OAI: oai:DiVA.org:oru-79733DiVA, id: diva2:1391142
Available from: 2020-02-03 Created: 2020-02-03 Last updated: 2020-02-28Bibliographically approved

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