Recurrent varicose veins: Investigation of the pattern and extent of reflux with color flow duplex scanning

Background. This study was conducted to investigate with color flow duplex imaging the patterns and the extent of venous valvular incompetence in recurrent varicose vein disease. Methods. One hundred thirty-four limbs of 123 unselected patients who arrived in the outpatient clinic with residual or recurrent varicose veins after undergoing an operation were included. Limbs with history of compression sclerotherapy before or after the operation were excluded. The long (LSV) and short saphenous vein (SSV) systems in all limbs were examined with color flow duplex imaging for detection of the sites and the extent of reflux. Results. Various patterns of recurrent valvular reflux were seen in both the LSV and SSV systems. Reflux confined to saphenofemoral junction alone or associated with reflux in the LSV system was seen in 29% of the limbs. Reflux in the whole LSV system was very common after saphenofemoral junction ligation was performed (chi-squared test, p < 0.01). Most of the limbs (53%) with recurrence in the LSV system had incompetent perforating veins. Incompetent perforators in the thigh were more common after ligation (23%) than stripping (10%), but this finding was not true in the calf. After saphenopopliteal junction ligation was performed, the more common pattern was the reflux in the SSV (75%), whereas after SSV stripping was performed, it was the reflux in the SSV tributaries (64%). Conclusions. Multiple patterns of reflux develop in recurrent varicose veins. Precise mapping of the reflux and identification of the possible causes are required to instigate appropriate treatment. Color flow duplex imaging is an efficient noninvasive diagnostic technique to identify venous reflux.