The natural history of ultrasound-detected recurrence in the groin following saphenofemoral treatment for varicose veins

Objective This prospective study sought to track the natural history of duplex ultrasound (DUS) detected varicose vein recurrence in the groin after surgical intervention during a 5-year period. Methods Patients were recruited from a previous prospective trial investigating outcomes after high ligation and stripping with and without patch saphenoplasty. Follow-up examinations of the lower limb venous systems using DUS, air plethysmography, and clinical assessment were carried out at 1, 6, 12, and 36 months. At 60 months, an additional detailed DUS scan of the groin was performed on those with recurrence, including vessel numbers, diameter, and reflux velocity, to characterize the state of this groin recurrence. Results In the 130 limbs at 5 years, ultrasound groin recurrence was detected in 82%, and visible varicose veins occurred in 83% (108 limbs). In contrast, recurrence with severe varices occurred in 47% (61 limbs) as clinical recurrence (Venous Clinical Severity Score less the stocking component >3) in 22% (29 limbs) and functional recurrence (venous filling index >2 mL/s) in 34% (43/125 limbs). The DUS pattern was junctional in 29 limbs (22%), nonjunctional in 37 limbs (29%), and mixed pattern in 40 limbs (31%). Compared with the 24 (19%) with no ultrasound-detected recurrence, severe visible varicose veins were significantly more common with each of these patterns and especially with multiple connecting vessels (odds ratio, 5.4; confidence interval, 1.5-19.5). The diameter and velocity of reflux through recurrent vessels in the groin did not correlate with disease severity, and no DUS feature in the groin was predictive of Venous Clinical Severity Score >3 or a venous filling index >2 mL/s. The appearance of DUS recurrence within the first year and other features, including residual lower leg reflux, body mass index, gender, and previous treatment, were more consistent predictors. Conclusions Early ultrasound recurrence is predominantly evidence of neovascularization and some small-vessel remodeling at the site of treatment. When it occurs, some visible varicose veins are inevitable. However, these appearances alone are not good predictors of severe clinical recurrence.