Prospective audit of surgery for varicose veins

Recent reports have demonstrated a high recurrence rate following varicose vein surgery. It has been suggested that this is due to inadequate surgery. This has been assessed by a prospective surgical audit.

Fifty limbs in 33 patients awaiting varicose vein surgery were examined before operation and 6 weeks after operation. A duplex scanner was used to detect sites of venous incompetence.

Eighteen operations were performed for recurrent disease, 38 limbs had an incompetent connection between the long saphenous vein or another superficial vein and the common femoral vein in the groin, and 11 limbs had saphenopopliteal incompetence. Following surgery, persisting incompetence existed in seven limbs in the groin and eight limbs in the popliteal fossa; this was due to inadequate surgery in 13 of 15 cases. Thirty-four operations were performed by trainees who were responsible for 14 of the 15 cases of persisting incompetence in the groin or popliteal fossa.

Improved surgical technique and training is required to reduce recurrence following varicose vein surgery.