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J Vasc Surg. 2004 Jul;40(1):98-105.

Silicone patch saphenoplasty to prevent repeat recurrence after surgery to treat recurrent saphenofemoral incompetence: long-term follow-up study.

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1
Department of Vascular Surgery, University Hospital Antwerp, Belgium. marianne.de.maeseneer@uza.be

Abstract

OBJECTIVE:

Barrier techniques have been proposed to improve the results of repeat surgery to treat recurrent saphenofemoral junction incompetence. We hypothesized that interposition of a silicone implant would contain postoperative neovascularization and thus reduce the incidence of clinical recurrence at 5-year follow-up.

METHODS:

We compared the results of repeat interventions with use of silicone sheeting with a control group without artificial implants. The study was performed in hospitalized patients in a level 3 referral center (University Hospital). All patients underwent new flush ligation in the groin, with stab avulsion of recurrent varicosities. Two closure techniques were compared: in group A (33 limbs) the groin incision was closed in two layers; in group B (35 limbs) a piece of silicone sheeting was sutured on the saphenous stump. Clinical examination and duplex scanning were performed after 1 and 5 years postoperatively. Limbs operated on were checked in particular for the presence of recurrent thigh varicose veins. Color-coded duplex scanning was performed to assess for the presence of clinically relevant neovascularization, defined as the presence of a new vein with diameter at least 4 mm and with pathologic reflux in direct connection with incompetent varicose veins at thigh level.

RESULTS:

Clinical examination after 1 year showed recurrent thigh varicosities in 24% of limbs in group A and 12% of limbs in group B (P =.369). After 5 years recurrent thigh varicosities were observed in 58% of limbs in group A and in 26% of limbs in group B (P =.009). Duplex scans after 1 year revealed neovascularization in 27% of limbs in group A and 6% of limbs in group B (P =.018). After 5 years neovascularization was present in 45% of limbs in group A and 9% of limbs in group B (P =.0007).

CONCLUSIONS:

The use of a silicone patch at repeat operation to treat recurrent varicose veins caused by new incompetence at the level of the saphenofemoral junction is associated with a lower incidence of recurrent thigh varicosities and neovascularization compared with a control group in which no additional barrier technique was used.

PMID:
15218469
DOI:
10.1016/j.jvs.2004.03.025
[Indexed for MEDLINE]
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