Retrograde stripping of recurrent varicose veins

Randomised Trial of Polytetrafluoroethylene Patch Insertion for Recurrent Great Saphenous Varicose Veins

OBJECTIVES

The aim of this study was to assess the possible value of a polytetrafluoroethylene (PTFE) patch in the treatment of recurrent varicose veins.

METHODS

Thirty-one patients (40 legs) with recurrent saphenofemoral junction incompetence were randomised to redo saphenofemoral ligation and great saphenous vein stripping with, or without the insertion of a PTFE patch over the ligated junction. Patients underwent assessment preoperatively, and at 6 weeks, 1 year and 2 years postoperatively with clinical examination, duplex imaging and completion of the Aberdeen Varicose Vein Symptom Severity Score (AVVSSS).

RESULTS

A total of 27 patients (32 legs) attended for assessment at 6 weeks, 25 patients (30 legs) at 1 year and 27 patients (32 legs) at 2 years. At 6 weeks, seven legs (22%) had an area of cutaneous numbness; all but one had resolved by 1 year. Four legs (13%) developed a groin infection, which required antibiotics, 2 had a groin haematoma and four had a seroma, all of which resolved spontaneously. The overall complication rate was 35% (11 legs), with no statistically significant difference between the groups. Four of 16 legs without a patch and five of 16 legs with a patch developed neovascularisation at the saphenofemoral junction on duplex imaging by two years postoperatively. Two cases of neovascularisation in the patch group and one in the no patch group directly resulted in clinical recurrence (p=1.0). There was an improvement in patients' AVVSSS two years postoperatively (p<0.03), that was similar in both groups.

CONCLUSIONS

In this study, insertion of a PTFE patch did not affect the rate of perioperative complications and it did not appear to contain neovascularisation.