Article: Three-dimensional venography aiding repeat surgery for the recurrence of varicose veins of the popliteal fossa: long term results

B. PUJADE-LAURAINE, R. LESAGE, D.W. FOSTER, V. PRUVOST-BITAR, M. MOURARET-NASCEMBENI, M. C. COËL, B. GROGNET-LENNE, P. THÉBAUT, H. MÉLET, P. COMACLE, T. TONDELEIR, V. DUPUY, P. RÖHRLE, A. PAQUET, P. BOUBLIL, P. ECHEGUT, B. FADEL, G. PINTO, E. FIEVET-BAUDEN, C. GUEDJ, D. ZEITOUN, S. RATTANI, M. CAMAGNA, E. DELORY, C. LAURENT, D. LELOUCHE, E. TAQUET-LOUINEAU, T. LE PHUC, R. BARBAROSSA, D. FAFET, F. RENAUD, J-P. BRUNETTO, L. THIEBAUT, H. VALLEZ, B. AZANCOT, J-F. BENNER, P. SKENADJE.

Hôpital Privé Nord Parisien, 95200 Sarcelles

Abstract

Objective: To assess the results of the repeat surgery for recurrence of varicose veins of the popliteal fossa when this repeat surgery is aided by three-dimensional venography.
Methodology and materials: 87 popliteal fossae that had previously undergone a surgical procedure for an incontinent small saphenous vein with varicose veins were studied in 77 patients. They had all been referred to us for repeat surgical procedure for a varicose vein recurrence of the same popliteal fossa from January 2006 to September 2013. All these repeat operations were aided by three-dimensional venography. Follow-up care (including long term sclerotherapy with or without wearing compression hosiery) was left to the referral’s physician’s judgment. Patients were recently telephoned and asked about their judgment regarding their surgical procedure and their venous disease. The probability of their varicose vein recurrence, and their survival rate was assessed.
Results: These patients were in excess weight or obese in comparison with the age and sex adjusted French population (ORMH = 3.2 CI 95% ORMH = 2 – 5.2 p<0.000001). The women had more children (p<0.02). The popliteal fossa could already have been operated twice or three times and patient’s other saphenous territories could have been operated on as well. The judgment of most patients (91%) about their surgical procedure aided by three-dimensional venography was positive, despite their nervous or thombotic complications. Ten cases out of 87 (11%) were unable to be followed up. The average follow-up time in years was 3.9 and the person’s years-at-risk was 278.8. The probability of varicose vein recurrence after one year was 8%, after two years 17%, and after five years 30%. The patients that had abandoned their follow-up care did worse (Hazard Ratio=8.43 (CI 95%=1.10 – 64.35) p=0.04).  For these patients, the probability of varicose vein recurrence after one year was 45%, after two years 52%, and after five years 76%. During the follow-up time, three deaths occurred. These deaths might be related to excess weight or obesity of these patients. These deaths accounted for an excess mortality in comparison with the age and sex-adjusted French mortality (Rate Ratio = 3.2 CI 95%=1.1 - 10 p=0.04).
Conclusion: three-dimensional venography aides repeat surgery for the recurrence of varicose veins of the popliteal fossa. However varicose vein recurrence of the popliteal fossa is addressed better by following several courses of treatment. The fight against the excess mortality of these patients may include that of excess weight.