Etiology and pathophysiology of varicose vein recurrence at the saphenofemoral or saphenopopliteal junction: an update

Recurrent varicose veins remain a common problem after varicose vein treatment. With the widespread use of duplex ultrasound and increasing experience in the field of ultrasound- guided procedures, the impact of both tactical and technical failure is likely to diminish. Progression of the disease and neovascularization, in particular after surgery at the level of the saphenofemoral junction (SFJ) or saphenopopliteal junction (SPJ), both have their impact on recurrence, and both factors may be interacting. After high ligation, with or without stripping, neovascularization has been attributed to local angiogenesis, transnodal lymphovenous connections, dilation of vasa vasorum, or disturbed venous drainage of the ligated tributaries of the SFJ. Another typical source of recurrence after surgery is a persistent refluxing residual stump at the SFJ or SPJ. After endovenous thermal ablation new or persistent reflux may be detected sonographically at the SFJ or SPJ residual stump as well. One of the veins often involved in recurrence after great saphenous vein ablation is the anterior accessory saphenous vein. Future studies are needed, including adequate preoperative duplex ultrasound investigation and long-term follow-up, to understand the impact of residual or recurrent reflux at the SFJ or SPJ on the incidence of clinical recurrence after different forms of varicose vein treatment.