Pregnancy as a possible reason for recurrent varicosity after laser crossectomy

Pregnancy is one of the most important factors which promote the development and recurrence of varicose veins.

Altogether 38 limbs of 33 women were evaluated who underwent laser crossectomy following childbirth and after that received US follow-up. Surgery was performed between October 2008 and October 2019. Timespan between surgery and pregnancy was 22.7±20.49 months. In 34 cases GSV, 2 SSV and in 2 cases GSV and perforator veins were treated. Diameter of treated veins was 6.26±3.25 mm. In most cases 1550 nm diode laser equipment and radial fiber was used (70%). Tip of the laser fiber was 1.0 later 0.5 cm to the femoral vein. Mean delivered energy was 100 J/cm along the saphenous veins and approximately double that near the SFJ.

Before gravidity there were flush closures of the SFJ with the femoral vein in 26 cases (EHIT1). In 12 cases there were stumps whose length was mean 7.5±3.73 mm. Between surgery and pregnancy none of them had any recurrency clinically nor with US. After delivery there were recurrent C2 varicosities in 18 cases (47.4%). Pathology of them were as follows: neo vascularization - 6; acc. ant. varicosity -5; perforator vein insufficiency -4 and recanalization -3 cases. This means that in 14/38 cases (36.8%) the SFJ became insufficient which contributed to recurrency. Few results are available about the impact of pregnancy on recurrency after varicose vein surgery.

Our results suggest that recurrent varicosity results are acceptable using laser crossectomy. We couldn't judge if any of the used techniques could influence those very strong factors which cause recurrent varicosity during pregnancy.