[Recurrent varicosity of the lesser saphenous vein. A 5-year follow-up]

Between January 1st, 1992 and December 31st, 1996 we performed 1189 variectomies, 127 (11%) of these patients with recurrent varicosis. Only 5 (4%) of them exhibited an isolated perforator vein varicosis and 15 (1%) an isolated varicosis of lateral branches of the lesser saphenous vein. In 66 cases (52%) we noticed, as it was expected, a recurrent varicosis of the saphenous vein. The 41 patients (32%) with recurrent varicosis of the lesser saphenous vein were analysed exactly in detail. We used the classification described by Fischer. According to this we divided them up as follows. Type I: insufficiency of the lesser saphenous vein stump or from lateral branches of the lesser saphenous stump. Type II: recurrence by the femoro-popliteal vein. Type III: recurrence from the lateral branches vein. We obtained from type I: 27 patients (65%), from type II 6 patients and 8 patients (20%) from type III. The recurrences from the stump of the lesser saphenous vein dominated in male patients with 25 of 33; in female patients the recurrences from branches of the lesser saphenous vein with 4 of 8. The lesser saphenous vein was removed in 33 cases completely, and partly in 8 cases at the first operation. The ligation of the termination of the lesser saphenous vein in patients with a type I recurrence was done 16 times in fascial level and 8 times above the fascial level at the first operation. All the 27 type I patients were undergoing a subfascial ligation of the termination of the lesser saphenous vein at the second operation. We noticed the following complications: 2 haematomas, 2 lymphatic fistulas, 1 paraesthesia and 1 ilio-femoral venous thrombosis. After the recurrent operation we noticed no type I and no type II recurrence during follow-up, 17 out of the 26 patients examined again were satisfied. The value of the different investigations, indications, technical details, modifications and the results are discussed.

The results demonstrate that most of the saphenous parvous vein stump recurrence would have been avoided by a sufficient ligation of the saphenous parvous stump at the first operation. It is obvious that an exact indication, a sophisticated operation technique and an experienced surgeon are necessary for successful therapy.