There is a certain recurrence rate in varicose vein surgery of lower limbs, but there is no specific recurrence rate statistics at present. But it can avoid the postoperative recurrence of a considerable part of varicose veins of lower limbs.
(1) The patient's great saphenous vein was not ligated. Many patients claimed that they had been stripped of the great saphenous vein and had surgical scars in the inguinal region, but B-ultrasound showed that the great saphenous vein still existed. This situation is often due to the lack of clinical experience of the surgeon and the branch as the main ligation method. Or you can't find the great saphenous vein and give up ligation. Preserving the intact great saphenous vein is the most common cause of varicose vein recurrence. Zhang Qiang, Department of Vascular Surgery, Shanghai Oriental Hospital
(2) inject hardener. Most sclerotherapy of varicose veins in China is carried out in small private medical institutions. Almost inevitably, only the varicose veins in the legs were blocked by sclerosing agent injection, while the trunk of great saphenous vein was not treated.
(3) The great saphenous vein is poorly closed or recanalized by laser or radio frequency.
(4) Small saphenous vein insufficiency. During the first operation, most doctors tend to ignore the lesions of small saphenous vein. First, because the great saphenous vein is behind the calf; Second, because the saphenous vein is deep, the expansion is not easy to be found. The great saphenous vein reflux will lead to the recurrence of varicose veins.
(5) Deep venous thrombotic diseases. When the deep vein is unobstructed, the operation is invalid because of the increase of venous pressure.
(6) Communicating venous insufficiency. Patients with communicating venous insufficiency caused by severe deep venous reflux are often accompanied by ulcers in the boot area. Some patients recurred after operation.
(7) Segmental ligation. Vein branches are very rich, and the vein wall has strong anticoagulant function. Segmental ligation without sealing or stripping veins often leads to varicose veins still existing due to blood filling.
Therefore, if you encounter recurrent varicose veins in clinic, you can start from the following aspects: First, check whether there is great saphenous vein residue, small saphenous vein insufficiency or communicating vein reflux with B-ultrasound. The second is to understand the patency of deep veins. The surgical method is to prescribe the right medicine according to the cause of recurrence. If the trunk of the great saphenous vein is preserved, it can be achieved by stripping or closing the great saphenous vein. For patients with saphenous vein insufficiency, the saphenous vein is stripped or closed. Endoscopic devascularization can be used for communicating vein reflux.
Of course, the best way to prevent varicose veins is to advise patients to find a professional and experienced vascular surgeon for treatment.
Professor Zhang Qiang (Dr. Smile) is the director of vascular surgery in Shanghai Oriental Hospital affiliated to Tongji University, and is a very authoritative expert in varicose veins, arteriosclerosis obliterans and deep vein thrombosis in China. Professor Zhang is approachable and highly responsible for patients, which is highly recognized by patients. Many patients have received enthusiastic help from Dr. Smile on Dr. Zhang Qiang's personal website.