[Understanding the poor results after surgery for superficial venous insufficiency]

Effectiveness and value of surgical treatment in varicose veins remains difficult to assess for many reasons. They are discussed in details in front of this general review devoted to poor results after varicose vein surgery. An other pathology is often associated with venous insufficiency and is frequently missed and responsible of poor results. Many factors contribute to make uneasy assessment of poor results. The lack of objective criteria to appreciate the natural evolution of varicose disease different from one patient to another. The difficulty to grade clinical disease severity. Results published before the use of modern preoperative investigations make their report obsolete. Precise data of surgical treatment undertaken are often not detailed. The quality of therapists (surgeon or phlebologist) is uneasy to check. The difficulty to assess results after treatment: subjective results (patient) vs objective results (audit). Duration of follow-up. Imprecise vocabulary to qualify results. Clinical assessment remains the cornerstone but supplementary investigations must be undertaken. Duplex-Scan is currently accepted as the gold standard investigation. Phlebography or (and) plethysmography can be helpful in some cases. After detailed assessment patients can be classified in different groups. This classification allows to determinate the most adequate treatment. In some selected patients redosurgery is strongly recommended. Prevention of recurrence after surgical treatment of varicose veins can not be complete. Strict respect of several rules can however reduce it. They can be summarised as follows: Respect of temporary of definitive contraindications to surgical treatment. Thorough investigation before surgery. Preoperative precise aim of what must be treated by the surgical procedure. Correct operative procedure.(ABSTRACT TRUNCATED AT 250 WORDS)