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. Reintervention 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.

Day Case Varicose Vein Operations: Patient Suitability and Satisfaction

Objectives: To define how many patients with varicose veins are suitable to have the operation carried out as a day case. To define how well the procedure is tolerated. Design: A prospective 6-month study. Setting: District General Hospital. Patients: One hundred and sixty-eight new patients and a separate group of 100 patients having a day case varicose vein operation. Interventions: New patients were assessed according to RCS guidelines. Postoperatively, patients completed a one-page questionnaire. Results: Of the 168 patients, 141 (84%) were suitable for a day case operation. The main indications for an overnight stay were associated medical conditions and social problems. Of the 100 patients having an operation, 90 stated they would have a similar procedure carried out as a day case again. In the first 2 postoperative weeks, 12 patients saw their GP and three a district nurse. No patients contacted their GP before the fifth postoperative day. Twenty-eight patients took no analgesia following discharge from hospital; 81 felt that their postoperative pain was less than or as they expected. Conclusion: Most patients with varicose veins are suitable to have a day case procedure, which is well tolerated and provides no additional workload for the GP.