[Recurrence following surgery of the gastrocnemius veins]

Routine preoperative investigation of chronic venous insufficiency of the lower limbs with echo-Doppler has brought to light the presence of reflux into the gastrocnemius veins in almost 30% of the patients. Surgical treatment to stop this reflux consists in dividing the gastrocnemius vein flush to the popliteal vein. Early postoperative investigation of patients operated on in this way, who are symptomless and with no residual varices, has revealed the presence of persistent, symptomless, postoperative reflux into the gastrocnemius veins. One hundred and six patients were checked six months postoperatively by Duplex Doppler scanning. On the basis of the anatomical and functional findings, postoperative incompetence of the gastrocnemius veins could be classified into several types according to the cause: 1. Persistence of a complete and incompetent gastrocnemius vein, probably missed at operation: 16 patients (15%). 2. Neoangiogenesis: 11 patients (10%). 3. Persistence of an incompetent lower gastrocnemius perforating vein: 17 patients (16%). Thus, echography has revealed that in 44 lower limbs out of 106 (42%) in which the gastrocnemius veins were operated on, six months postoperatively evidence of reflux into the gastrocnemius venous network was present. All these patients were asymptomatic. In a sub-group of 48 lower limbs which had an interval Doppler check at 2 months: 6 already showed a reflux (12.5%), in 11 the gastrocnemius reflux appeared between the second and the sixth months (23%), 31 showed no reflux at 6 months (64.5%). From these findings, certain rules on the surgery of the gastrocnemius veins have been drawn up.