Clinical relevance of neovascularisation on duplex ultrasound in the long-term follow-up after varicose vein operation

Objective: To evaluate the clinical relevance of neovascularisation at the saphenous ligation site. Design: Long-term follow-up after previous varicose vein surgery in a single patient group. Setting: Vascular clinic of a university hospital. Patients: Eighty-two patients (106 limbs) with a mean follow-up period of 56 months after correct saphenous ligation were submitted to duplex scanning. Intervention: Clinical assessment and colour duplex scanning of all the operated limbs. Intervention in 15 limbs with perioperative evaluation of recurrent veins. Main outcome measures: Limbs with and without recurrent varicose veins were classified according to the degree of neovascularisation: grade 0 = no new communicating veins, grade 1 = tiny new vein with diameter <4 mm, grade 2 = new communicating vein with diameter >4 mm and pathological reflux. On reintervention the presence of neovascular veins at the site of the previous ligation was checked. Results: In 68 limbs without recurrent varicose veins, grade 0 was observed in 50 limbs (74%), grade 1 in 12 limbs (18%) and grade 2 in six limbs (9%). In 38 limbs with recurrent varicose veins, grade 0 was diagnosed in eight limbs (21%), grade 1 in four limbs (11%) and grade 2 in 26 limbs (68%). In 15 limbs with recurrent varicose veins and grade 2 neovascularisation, reintervention confirmed the duplex findings. Conclusions: The presence of grade 2 neovascularisation was associated with the recurrence of varicose veins, suggesting a causal relationship.