Causes of varicose vein recurrence: Late results of a randomized controlled trial of stripping the long saphenous vein

Background: The purpose of this study was to investigate the long-term outcomes following stripping of the long saphenous vein during primary varicose vein surgery and to identify factors which may predict recurrence and the need for reoperation. Methods.-The original study was designed as a randomized trial of 100 patients (133 legs) who underwent saphenofemoral ligation with or without long saphenous vein stripping. After invitation 11 years later, 51 patients (74 legs) underwent clinical review and duplex imaging and completed an Aberdeen Varicose Vein Symptom Severity Score (AVVSSS). The hospital notes of the original cohort of patients were used to compile cumulative data and assess predictive factors. Results. A cumulative total of 83 legs had developed clinically recurrent varicose veins by 11 years (62%). There was no statistically significant difference between the ligation-only and the stripping groups. Reoperation was required for 20 of 69 legs that underwent ligation alone compared with 7 of 64 legs that had additional long saphenous vein stripping (relative risk [RR], 2.65; 95% confidence interval, 1.20 to 5.84; P =.012). By life table analysis, freedom from reoperation at 11 years was 70% after ligation, compared with 86% after stripping (P =.01). The presence of neovascularization (RR, 2.88; P =.15), an incompetent superficial vessel in the thigh (RR, 3.24; P =.03) or an incompetent saphenofemoral junction on duplex imaging at 2 years postoperatively (RR, 4.89; P =.0001) increased the risk of a patient's developing clinically recurrent veins. Patients with visible recurrent varicose veins had a significantly worse AVVSSS (P =.001). Conclusion: Stripping the long saphenous vein is recommended as part of routine varicose vein surgery as it reduced the risk of reoperation by 60% after 11 years, although it did not reduce the rate of visible recurrent veins.