The role of incompetent perforators in the development of recurrences after surgery for primary lower leg varices

Abstract

Background. Valve incompetence of perforating veins (IPVs) significantly influences the competence of superficial and deep vein trunks, also having an impact on clinical symptoms of vein disease. Opinions concerning the role of IPVs in the development of recurring varicose veins (RVV) vary substantially. The aim of the study was to analyze the role of IPVs in the development of recurrent varicose veins after surgical treatment of primary varicose veins of the lower limbs.
Material and methods. Five hundred and seven patients with primary lower limb varicose veins were examined. All the patients underwent classical operation for varices between 1996 and 2006.
Results. The results of duplex examinations of the venous system performed before and after surgery were analyzed. Mean follow-up duration was 89.7 ± 31.2 months. Mean number of IPVs in preoperative examinations in limbs without later recurrence was 0.5 ± 0.8, whereas in limbs with recurrence it reached 1.5 ± 1.6 (p < 0.001). Evidence of any insufficient perforating vein (excluding Dodd perforating vein) significantly increases the risk of RVV. Incompetent perforators were found in 49% of limbs with RVV. Incompetence of leg perforators was noted mainly in cases of incomplete great saphenous vein (GSV) extirpation, whereas insufficient vessels of the adductor canal were the main cause of thigh recurrences despite proper ligation of the saphenofemoral ostium. Evidence of insufficient Hunter perforating vein or more than three IPVs in any location increased the risk of RVV development more than eleven-fold.
Conclusions. Evidence of IPVs on limbs in patients qualified for surgical varicose vein treatment is a significant risk factor of RVV development. Since evidence of insufficient Hunter perforating veins or more than three incompetent perforators in any location increases the risk of RVV development more than eleven-fold, expedient ligation of these vessels should be considered during the primary procedure.

Acta Angiol 2010; 16, 4: 158–171