Femoral vein valve incompetence as a risk factor for junctional recurrence
Background Recurrent varicose veins occur up to 80% of procedures. The sapheno femoral junction can be involved in more than 50% of cases. A detailed pathophysiological explanation of the phenomenon is still missing. The aim of the present work is to evaluate the role of femoral vein incompetence as risk factor for sapheno femoral junction recurrence. Methods Three hundred eighty one patients presenting an incompetent great saphenous vein system and eventually also an incompetent femoral tract (C2 6EpAsdPr) underwent a great saphenous vein high ligation with flush ligation also of the incompetent tributaries along the leg, sparing the saphenous trunk. Pre operatively, all patients underwent a sonographic evaluation assessing the superficial and deep venous systems, including a detailed analysis of the iliac femoral vein tract above the sapheno femoral junction. A retrospective statistical analysis assessed the recurrence risk associated with iliac femoral vein tract incompetence. Results In a 5.5 1.9 years follow up, great saphenous vein trunk reflux recurrence was detected in 45/381 (11.8% cases. The reflux source was found in a reconnected sapheno femoral stump in 11/45 cases (24.5% in the pelvic network in 8/45 cases (17.8% in a neovascularization process in 7/45 (15.5% and in a newly incompetent great saphenous vein tributary in 19/45 (42.2% At the pre operative assessment, iliac femoral vein tract reflux was present in 7 (26.9% of the 26 cases who developed a sapheno femoral junction recurrence and in 25 (7% of the 355 patients who did not demonstrate sapheno femoral junction recurrence (odds ratio: 4.8; confidence interval 95% 1.8 12.6; p .003) Discussion Despite many technical diagnostic and therapeutic refinements, varicose veins recurrence remains a frequent event. The present investigation points out the association among iliac femoral vein tract incompetence and sapheno femoral junction recurrences after high ligation.
Phlebology