A Nondraining Saphenous System Is a Factor of Poor Prognosis for Long-Term Results in Surgery of Great Saphenous Vein Recurrences

OBJECTIVE: The objective was to examine the evolution of superficial venous disease after the suppression of every principal or accessory saphenous trunk. METHODS: To achieve this aim, the long-term results of complete ablation of saphenous trunks and varicose veins during redo surgery for recurrent great saphenous veins have been assessed. Of 170 extremities (137 patients), 4.9 years of follow-up data based on physical and ultrasound examinations were obtained for 119 extremities (100 patients). RESULTS: No varicose veins could be observed for 27.7% of extremities. For 45.3% diffuse varicose veins without reflux between the deep and superficial system could be observed. For 26.8% varicose veins and a new reflux had developed between the deep and superficial venous system. After 5 years, recurrent varicose veins were significantly associated, before operation, with the absence of insufficient residual saphenous trunk and with the presence of diffuse varicose veins (p=0.015) and, during redo surgery, with a higher number of phlebectomy incisions (p=0.02). CONCLUSIONS: The absence of superficial venous drainage (complete removal of varicose veins and saphenous trunk) leads to appearance of rerecurrences in the surgery of great saphenous vein recurrences, 72.3% of the cases show still new varices at the 5-year follow-up. This poor prognosis probably suggests the presence of a nondraining superficial venous system.