PolytetraOuoroethylene patch saphenoplasty: Is it effective against recurrent varicose veins?

Abstract

Background: Recurrent varicose veins after surgery (REVAS) are a common, complex and costly problem. The possibilities for recurrent varicose veins after correctly ligated SFJ may be due to: dilatation of preexisting venous tributaries from the common femoral vein (CFV) or formation of new veins as a result of angiogenic stimulation termed neovascularisation. Interposition of a prosthetic implant covering the saphenous stump has been called ''patch saphenoplasty. The aim of the present study is to evaluate the use of polytetrajluroethylene (PTFE) patch sutured over the saphenofemoraljunction (PTFE saphenoplasty) to reduce the incidence of recurrent varicose veins. Patients and methods: This study was conducted in General and Vascular Surgery Unit at Mansoura University hospital between March 2007 and November 2010.Patients were included ifthey had varicose veins from the CEAP clinical classification: C 2-5; recurrent varicose veins and isolated short saphenous vein varicosity were excluded. 320 patients (368 limbs) were eligible for the study; The patients were randomized into two groups; group L flush ligation of the GSV was performed at the SFJ without using any technique to contain possible postoperative neovasculorization; group IL underwent PTFE saphenoplasty (rectangular piece (2 x 3cm) of PTFE was sutured on the saphenous stump). Results: Both groups were comparable as regard patients' characteristics.The global incidence of early postoperative complications was higher in-group II than group I (9.4% vs. 3.8%) (PO.OOJ). Two months postoperative clinical and duplex examination revealed no clinical recurrence or neovascularization at the site of SFJ ligation in both groups.One-year postoperative clinical examination revealed recurrent thigh varicosities in 15/187 limbs in-group I (8 %) and in 8/181 limbs (4.4 %) in-group II. By duplex examination neovascularization occurred in 37/187 (19.7%) limbs in-group I (22 limbs grade 2 & 15 limbs grade 3) but in-group II neovascularization occurred in 19/181(10.5%) limbs (11 limbs grade 2 & 8 limbs grade). (P 0.001) Conclusion: Interposition of PTFE implant at the level of the ligated saphenofemoral stump significally reduces the incidences of clinical recurrence and neovascularization