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Published on: January 15, 2017
Histological Differentiation of Neovascularisation and Residual Veins in Groin Recurrence
Thomas Falkenstein1, Markus Stücker2, Johann Ahrendt1
1Ruhr University Bochum, Medical Faculty, Clinic for Vascular Surgery, St. Josef Hospital Bochum, Bochum, Germany; Clinic for Dermatology of Ruhr University Bochum, Interdisciplinary Vein Center of the Dermatological and Vascular Surgery Clinics at St Maria-Hilf Hospital Bochum, Catholic Hospital Bochum, Bochum, Germany.
Objectives:
Recurrence in the inguinal region following surgery for saphenofemoral insufficiency remains a major challenge in venous surgery. Histologically, a distinction can be made between residual stump and neovascularization. Using hematoxylin-eosin and Elastica-van Gieson staining, this study systematically analyses samples from recurrent saphenofemoral lesions.
Methods:
Patient demographic data, the clinical CEAP stage, and the Venous Clinical Severity Score were recorded. A preoperative duplex ultrasound was performed. The resected specimens were processed using standard staining methods. During histological examination, a distinction was made between residual venous tissue and neovascularisation.
Results:
A total of 203 samples were available for histopathological evaluation. In the histological evaluation, 197 samples were classified as stump tissue (97.0%) and 6 samples as neovascularization (3.0%). The diagnostic specificity and predictive value of duplex sonography and intraoperative macroscopic classification between residual stump and neovascularisation was limited.
Conclusion:
Residual venous structures represent the predominant morphological substrate of groin recurrences after saphenofemoral surgery. True neovascularisation occurs only in a few cases and should be regarded as a secondary phenomenon rather than a primary cause of recurrence. Surgical precision during the initial intervention may play an important role in recurrence prevention.
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