To test the hypothesis that sapheno-femoral recurrence of varicose veins may be prevented by containment of neovascularization.Design:
Prospective minimum 4-year follow-up by surgical exploration and morphological examination of recurrent vessels in all limbs with clinical or phlebographic evidence of sapheno-femoral recurrence.Setting:
Varicose vein clinic of a teaching hospital.Interventions:
Sapheno-femoral ligation and multiple ligation (group 1); sapheno-femoral ligation, interposition of cribriform fascia and multiple ligation (group 2); sapheno-femoral ligation, interposition of artificial implant and stripping (group 3).Main outcome measures:
Incidence of sapheno-femoral recurrence.Results:
The incidence of sapheno-femoral recurrence through neovascularization was lower (p < 0.001) in groups 2 and 3 after containment of neovascularization at the sapheno-femoral junction by cribriform fascia or artificial implant than in group 1 after ligation alone (3% and 1% vs 25%, respectively). The incidence of recurrent or persistent varices distal to the groin was lower (p < 0.001) after stripping (group 3, 57%) than after multiple ligation (group 1, 93%; group 2, 81%).Conclusions:
Sapheno-femoral ligation, interposition of cribriform fascia or artificial implant at the sapheno-femoral junction, and stripping is a more effective treatment of varicose veins than sapheno-femoral ligation and multiple ligation.