Recurrence of Varicose Veins After Surgery

• Autor(a) principal: Catarina Maria Vieira Brazão
• Data de Publicação: 2022
• Tipo de documento: Dissertação
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: https://hdl.handle.net/10216/142049
• topic: Medicina clínica; Clinical medicine

Introduction: Recurrent varicose veins after surgery (REVAS) are a common and costly problem of the available treatments and the etiology of these recurrences is still poorly understood. Our aim is to analyze patient's characteristics that could significantly contribute for REVAS. Methods: This was an observational, retrospective cohort study, that included consecutive patients who underwent VVS in a tertiary hospital in 2016. Patients were excluded if: did not have a preoperative lower limb venous ultrasound registry or if did not have phone contact available. All included patients answered to a questionnaire about demographics, comorbidities, life-style habits, and the current venous disease status. Surgery type and Doppler-ultrasound details were extracted from the clinical registries. Primary outcomes were symptomatic improvement, CEAP improvement and rate of secondary intervention due to REVAS at 5 years after surgery. Secondary outcome was to compare patients submitted to first versus redo VVS in a case-control design. Results: From a total of 1115 patients that underwent VVS in 2016, 328 were included in the study. The majority of patients were women (74%) and the mean age at intervention was 4911 years. Symptomatic improvement 5 years after surgery was referred by 89 patients (27.1%). Undergoing the first VVS was associated with symptomatic improvement (30.6% vs 18.5% in redo VVS; P=0.026). CEAP improvement 5 years after surgery was reported in 162 patients (49.4%). Male gender (34.0% versus 18.2%; P=0.002), absence of osteoarticular pathology (95.1% versus 88.6%; P=0.032), absence of superficial vein thrombosis history (79.6% vs 68.7%; P=0.024) were associated with CEAP improvement. Rate of secondary intervention due to REVAS was 4.9% at 5 years (Figure 1). Ninety-two patients (28%) from the whole sample had redo VVS. Patients undergoing redo VVS were more often treated with foam venous injection compared to patients that had their first VVS (3.3% vs 0%; P=0.02). Furthermore, patients undergoing redo VVS were older (48.3 vs. 58.6 years; P=0.01), had more often a history of superficial vein thrombosis (19.6% vs. 42.2%; P<0.01) and of deep vein thrombosis (1.7% vs 6.5%; P<0.023). Conclusion: At 5 years, symptomatic and CEAP improvement after VVS is low, particularly for women, in patients with osteoarticular pathology or history of superficial vein thrombosis and after redo VVS. Further studies considering lifestyle risk factor and comorbidities as a cause for varicose veins recurrence are of major importance to better discuss with the patients the risks and benefits of a VVS.