Patterns of Incompetence in Patients with Recurrent Varicose Veins: A Duplex Ultrasound Study

Abstract

Objectives: To identify the patterns of venous incompetence in patients with recurrent varicose veins using duplex ultrasound scanning. Setting: Oldchurch District General Hospital, Southeast England. Patients and methods: 836 patients (581 women, median age 51 years (range 22–86 years) and 255 men, median age 53 years (range 23–28 years) referred to the vascular laboratory for the assessment of recurrent varicose veins. Duplex ultrasonography was undertaken by an experienced operator to evaluate the venous system in the lower limbs. A total of 1254 limbs with recurrent varicose veins were studied. Results: Recurrent reflux was found at the sapheno-femoral (SFJ) or saphenopopliteal junction (SPJ) in 43% of cases. The source of recurrent varices was an unoperated SFJ or SPJ in 386 (31%) limbs. Thigh perforators accounted for varices in 16% of limbs. Conclusion: Nearly half of recurrences were attributable to inadequate surgical treatment at the initial operation or possible angiogenesis. Nearly a third of recurrences originated at previously unoperated sites, confirming a need for objective venous assessment before recurrent varicose vein surgery.