Role of valvular insufficiency of the femoral vein in clinical course and relapse of lower limb varicosity

: The authors carried out a comparative analysis of 488 patients with varicose disease. Of these, 107 patients suffered from class 4 varicosity and reflux along the femoral vein down to the middle third of the femur and below with the duration of more than 1.5 s, and 381 subjects had class 2 - 3 varicose disease without reflux along the femoral vein. The patients in the both groups were sex- and age-matched, with the overwhelming majority of them being women. Group One patients in the preoperative period had clinical class II and III chronic venous insufficiency (CVI) according to the CEAP classification, with the prevailing of class III. The majority of these patients were postoperatively transferred to CVI of clinical classes 0 and I. A similar picture with a difference in the outcome was observed in Group Two patients, the majority of whom had clinical class II CVI according to the CEAP classification, with the overwhelming majority of them having postoperatively been transferred to clinical class 0 and I CVI. Initially, all the patients from Groups One and Two were diagnosed to have been suffering from varicosity of lower-limb subcutaneous veins. During one year after the operation, varicosity was virtually absent in the patients of the both groups, however by ten years of dispensary follow-up the pathology was observed to have reappeared in approximately the same percentage of the patients involved. Studying the long-term surgical outcomes showed that the number of relapsing varicosity in the both groups did not differ significantly, having amounted to 25% and 23% of the patients in Groups One and Two, respectively. According to the findings obtained, the relapses having developed in the overwhelming majority of the patients in the both groups were caused by a reflux along the perforated veins, which either reappeared, or had not been duly removed intraoperatively, as well as by a long stump of the great saphenous vein with an altered influx, or varicosity in the previously intact basin. The integral score of the quality of life (according to the CIVIQ 2 scale) in the groups after the operations did not differ significantly. However, within the groups, there was certain difference between the subgroups comprising the patients in whom complete recovery was attained and those having developed relapses, with this difference in Group One patients commencing to emerge approximately after 7 - 8 postoperative months, to become statistically significant by the 4th - 5th year of the dispensary follow-up, while in Group Two patients this difference began to be seen as early as 2 months after surgery, also becoming statistically reliable 4 - 5 years later. According to our findings, a vertical venous reflux is not the cause of recurrent lower limb varicosity, nor does the dynamics of the quality of life of the patients involved depend upon either presence or absence of a reflux. Therefore, a reflux along the femoral vein does not exert any significant influence on either the course, or relapses of varicose disease.