The role of postoperative neovascularisation in recurrence of varicose veins from historical background to today's evidence

Recurrence of varicose veins at the sapheno-femoral or sapheno-popliteal junction can not always be explained by technical inadequacy of the original intervention. Its development has also been attributed to neovascularisation in the granulation tissue around the ligated saphenous stump. Already in the 19(th) century, surgeons had noticed that a new vein channel could be formed after ligation or extirpation of a piece of a vein, which could be responsible for recurrence after surgery. After the introduction of the 'high ligation' (crossectomy) in the groin, this theory became less popular. The majority of authors in the 20(th) century claimed that recurrence was due to the development of incompetence in pre-existing collaterals, which had not been adequately ligated by the previous surgeon. During the period 1960-80's, Dr Glass (Belfast) was one of the first surgeons to focus again on recurrence of varicose veins through re-growth of veins or 'neovascularisation' in interesting series of clinical and experimental work. Neovascularisation seemed to play a crucial role in recurrence after correctly performed sapheno-femoral ligation. With the introduction of duplex scanning, postoperative observation of the phenomena happening at the ligated sapheno-femoral or sapheno-popliteal stump has nowadays led to a better understanding of the causes of varicose vein recurrence. Neovascularisation at the ligated stump seems to play a key role in recurrence, which explains why ongoing research efforts are mainly directed at mitigating recurrent reflux related to neovascularisation.