The Management of Short Saphenous Varicose Veins: Recurrent Junctions is the Concern

Abstract

We read with great interest the article by Winterborn et al. entitled ‘The management of short saphenous varicose veins: A survey of members of the Vascular Surgical Society of Great Britain and Ireland, EJVES 2004;28:400–403’. Few points remained unclear. Recurrence is the main source of anxiety for surgeons in SPJ surgery. The article stated that ‘formal exploration of the recurrent sapheno popliteal junction (SPJ) is employed by 38%’. What did the rest (62%) of the responders do in the recurrent SPJ cases? and how many do not perform redo-surgery. Secondly, we do agree with the authors that improper dissection of the SPJ could be one of the explanation for high rate of recurrence, specially, with this practice—unlike in the sapheno femoral junction area—surgeon are missing tributaries including Giacomini vein which is known to be present in 70% of patients. 1 And finally, the authors quoted the high rate of technical failure and missing of SPJ in SSV surgery (22% as per Rashid et al. 2 ) and the chance of nerve injury. Yet there was no data about the follow up and how it should be conducted. In a survey carried out by our group, to the VSSGBI, about the controversies in management of popliteal fossa incompetent superficial venous systems; routine follow up post-operatively is practiced only by 58% of the responders, at a mode of 6 weeks. This is mostly (92%) by clinical examination, with 4.7% using duplex scanning and 2.5% using a nurse run clinic for the follow up. The data about recurrence suggest a clear indication for routine postoperative duplex scan as a follow up. Nevertheless, the funding issue might be the obstacle against that.