Clinicopathological evidence that neovascularisation is a cause of recurrent varicose veins

Objectives: Recurrent varicose veins may result from poor initial surgical technique or progression of varicosities in collateral veins. In some cases new veins may develop at the saphenofemoral junction (neovascularisation) and cause recurrent saphenofemoral incompetence. This was a histological study of recurrent varicose veins. Design: This clinicopathological study included 20 patients (median age 55 years) who had surgery for recurrent saphenofemoral incompetence. Materials and methods: A total of 28 legs had groin re-exploration with repeat flush saphenofemoral ligation. The venous tissue block from the saphenofemoral region (including the proximal thigh varicosity) was excised and orientated for histological analysis. Evidence of neovascularisation was sought using routine histological sections and S100 immunohistochemistry. Results: At operation, thin-walled, serpentine neovascular veins were detected clinically as the principal cause of recurrence at 19 groins. In five groins recurrence was due to a residual missed vein at the saphenofemoral junction, and in four recurrence was caused by cross groin collaterals. On histological sections, evidence of neovascularisation was present in 27 of 28 groins. In eight it co-existed with the veins missed at the original operation but it was the sole identified cause of recurrent saphenofemoral incompetence in 19 (68%) groins. Conclusions: Neovascularisation was the principal cause of recurrent saphenofemoral incompetence in this series.