PolytetraOuoroethylene patch saphenoplasty: Is it effective against recurrent varicose veins?

Background: Recurrent varicose veins after surgery (REVAS) are a common, complex and costly problem. The possibilities for recurrent varicose veins after correctly ligated SFJ may be due to: dilatation of preexisting venous tributaries from the common femoral vein (CFV) or formation of new  veins  as a result  of angiogenic stimulation termed  neovascularisation. Interposition of a prosthetic implant  covering  the saphenous  stump  has been called ''patch saphenoplasty." The aim of the present study is to evaluate the use of polytetrajluroethylene (PTFE) patch sutured over the saphenofemoraljunction (PTFE saphenoplasty) to reduce the incidence of recurrent varicose veins. Patients and methods: This study was conducted in General and Vascular Surgery Unit at Mansoura University hospital between March 2007 and November 2010.Patients were included ifthey had varicose veins from the CEAP clinical classification: C 2-5; recurrent varicose veins and isolated  short saphenous  vein varicosity  were excluded.  320 patients  (368 limbs) were eligible for the study; The patients were randomized into two groups; group L flush ligation of the GSV was performed at the SFJ without using any technique to contain possible postoperative neovasculorization; group IL underwent  PTFE saphenoplasty (rectangular piece (2 x 3cm) of PTFE was sutured on the saphenous stump). Results: Both groups were comparable as regard patients' characteristics.The global incidence of early postoperative complications was higher in-group  II than group I    (9.4% vs. 3.8%) (PO.OOJ). Two months  postoperative clinical  and duplex  examination revealed  no clinical recurrence or neovascularization at the site of SFJ ligation in both groups.One-year  postoperative clinical examination revealed recurrent thigh varicosities in 15/187 limbs in-group I (8 %) and in 8/181 limbs (4.4 %) in-group  II.  By duplex examination neovascularization occurred  in 37/187  (19.7%) limbs in-group I (22  limbs  grade  2 & 15 limbs  grade  3) but  in-group  II neovascularization occurred  in 19/181(10.5%) limbs (11 limbs  grade 2 & 8 limbs grade). (P 0.001) Conclusion: Interposition of PTFE implant at the level of the ligated saphenofemoral stump significally  reduces the  incidences of  clinical recurrence and  neovascularization