Retrospective evaluation of the need of a redo surgery at the groin for the surgical treatment of varicose vein

Background

Surgical treatment for varicose recurrence (STVR) involves removing all sources of reflux from the deep venous network to the superficial venous network. STVR is usually more complex and aggressive than first-line treatment by stripping, particularly for redo surgery at the groin (RSG). This retrospective study compared traditional STVR and a less aggressive surgical approach focusing on treatment of the varicose reservoir and avoiding RSG if possible.

Method

Two successive periods of STVR after great saphenous vein stripping were compared: traditional STVR (T1) and STVR focusing on the varicose reservoir (T2). We reviewed postoperative complications and studied the hemodynamic and clinical results.

Results

During T1 and T2, we operated 473 legs in 288 patients (236 women, 52 men) to treat varicose recurrence after great saphenous vein stripping. Mean age was 60.83 years (range, 28-88 years). We operated on 137 patients during T1 and 151 during T2. Patients had similar demographic data, CEAP classification, and Venous Disability Score. Inguinal reflux occurred in 73.9% of T1 patients and in 74.4% of T2 patients. We performed RSG in 66.0% of T1 patients and in 2.2% of T2 patients (P < .05). We did not use echo-guided sclerotherapy in addition to primary STVR. Tumescent local anesthesia was used in 96.2% of STVR in T2 vs 4.0% in T1 (P < .05), and 95.3% of T2 procedures were outpatient vs 13.7% of T1 (P < .05). Outcomes of limbs presenting an inguinal reflux treated with RSG during T1 (group 1) and without RSG during T2 (group 2) were compared. Postoperative complications occurred in 6.7% in group 1 vs 0.5% in group 2 (P < .05), with inguinal complications predominating. The mean cost of the procedure per limb was €1,195.88 in group 1 vs €863.08 in group 2 (P < .0001). After 3 years of follow-up, Kaplan-Meier life-table analysis showed group 1 and 2 patients had similar rates of freedom from inguinal reflux (90.8% vs 92.9% survival rate) and from varicose repeat-recurrence (90.8% vs 91.9% survival rate). Group 1 had better results for the Venous Disability Score (0.38 vs 0.58, P = .02) and cosmetic improvement (94.2% vs 84.2%; P = .00032).

Conclusion

STVR focusing on the varicose reservoir and avoiding RSG led to a minimally invasive procedure and a reduction in postoperative complications, with good medium-term clinical and hemodynamic results, particularly for symptoms improvement and cosmetic appearance, with a lower cost vs traditional STVR with RSG.