The duplication of the long saphenous vein as a cause of varicose vein recurrence

Abstract

The Long Saphenous vein (LSV) is a long vessel located at the inner face of the femoral and the tibial aspect of the Iower leg. Venous insufficiency as a consequence of a primary venous wall malfunction or a weakness of the venous valves. is mainly located on the (LSV) territory. On the other hand, the incidence of recurrence of vari­cose veins is very high (7.2-8.7%). This can be as a con­sequence of both a bad surgical technique at the groin sec­tion and the ligation of the (LSV) or as a consequence of an incompetent perforating vein. However. one missing cause of recurrence can be the duplication of the saphe­nous trunk. The incidence of this anomalous situation has not been studied enough, and some authors establish that it can be found in 6-62% of the extremities. MATERIAL AND METH0DS: We combined an eco-doppler study of 126 lower extremities with varicose veins recu­rrence and an anatomical study of I O LS V. in order to investigate how many recurrences can be the result of the presence of a double long saphenous vein trunk, and 10 prove that anatomically this situation is true. Both eco-doppler and anatomical explorations were developed as standard techniques. RESULTS AND DISCUSSION: The eco doppler shows that the LSV was the first point where the reflux could be detected (75.5%), followed by the ankle perforating veins (37.4%) and the crural perforating veins (31.9%). The high incidence of LSV insufficiency was related to both the crural and ankle insufficient perforating veins (28.8% and 33.5%, respectively). Anatomical studies show that the long Saphenous vein (LSV) can be duplicated in a higher or a lower exten­sion, and we could find it in 60% of the studied legs. Perforating veins can join the femoral vein directly with the LSV, which can explain the high incidence of LSV reflux recurrence. In conclusion, during duplex examination for varicose vein surgery, special attention must be paid to the dupli­cations of the LSV. After surgery, the remaining trunk can increase the diameter, and also, a perforating vein can develop a valve insufficiency as the result of the recu­rrence of the varicose veins.