Histopathology of Neovascularisation Observed During Saphenofemoral Re-Do High Ligation

The primary aim of this study was to assess the histopathological criteria of neovascularisation following saphenofemoral high ligation with regard to the delineation of the pathophysiology of the process. The secondary aims were to describe the perivenous morphological changes and to present cost effective agents to histopathologically diagnose neovascularisation.

In a prospective study design, vein samples of consecutive patients with recurrent varicose veins in the groin undergoing surgery were collected. The samples were analysed by a vascular histopathologist with a light microscope using standard staining techniques.

The study population comprised 35 patients, 24 of whom were female (69%). Histopathologically, 28 samples (80%) showed typical aspects of neovascularisation. The remaining seven specimens (20%) showed thickened residual veins. An irregular vascular network, increasing perivenous collagen and elastic fibres and perivenous lymph nodes were observed. Present venous valves were the main criterion for residual veins. A surprising finding was the presence of scar tissue in the views of reparative incomplete new valves. Standard staining agents were sufficient to make the diagnosis of neovascularisation in 73% of the samples and reduced the cost by 30% compared with the regular use of specific markers.

The histopathological analysis of operative specimens may clarify whether a varicose vein recurrence is the result of neovascularisation or some other cause. Although interesting for research, academic interest, and classification, this may be of very limited clinical relevance for the patient.