Recurrent varices after surgery (REVAS) : a clinical and color Doppler ultrasound scan analysis

BACKGROUND: To evaluate clinical pictures, symptoms and etiology of recurrent varices after surgery (REVAS) through a clinical and color-Doppler-ultrasound scan (CDUS) analysis. METHODS: During a three-year period, data about 9043 consecutive outpatients were collected. Among these, 160 patients (1.8%) were affected by REVAS. Data about risk factors, types of primary vein surgery, symptoms, clinical and CDUS characteristics were analyzed using the Clinical, Etiology, Anatomy and Pathophysiology (CEAP), Stonebridge and Perrin classifications in order to evaluate clinical and anatomical varices patterns. RESULTS: Family history for chronic venous disease (90%), sedentary lifestyle (61.9%) and obesity (11.9%) were the most representative risk factors. REVAS symptoms were rather heterogeneous, although only 10% of cases was fully asymptomatic. CEAP classification showed a prevalence of C2 and C3 class (56.3% and 35% respectively). About half of inguinal REVAS was connected from a great saphenous vein residual stump (Stonebridge type 1). Lower limb perforating veins resulted associated to REVAS in 43.8% of cases. CONCLUSIONS: REVAS remain a major and still unsolved problem in patients following varicose veins surgery. Their clinical pictures and symptoms are heterogeneous and require a watchful analysis in order to identify both etiology and natural history.