(1) 4% of patients evaluated for leg vein problems had previously undergone vein "stripping" surgery, with recurrent varicose veins present in 71 patients. (2) Recurrence was often due to residual or accessory saphenous veins, perforator veins, or neovascularization. (3) 73% of patients were treated with endovenous laser ablation (EVLA) of saphenous veins, with the majority reporting symptomatic improvement and vein closure at follow-up.

1. Recurrent varicose veins after vein “stripping” surgery.
Retreatment with endovenous laser ablation.
XVII World Meeting of the International Union of Phlebology
September 8-13, 2013
Hynes Convention Center
Boston, Massachusetts
USA
Primepares G. Pal, MD, RPVI, Jacqueline S. Pal, CNP, RPhS, Rachel Isaak, BA, RVT.
Minnesota Vein Center, North Oaks, Minnesota 55127 USA
email: dr.p.pal@mnveincenter.com
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2. No relevant financial disclosures
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3. Recurrence of varicose veins after vein “stripping”
4% of patients evaluated had vein “stripping” after 2000
2,347
Patients Evaluated for Leg Vein Problems (2007 – 2012)
(9%)
Vein “stripping” surgery
219
Survey Group - 71 Patients
•
•
Presence of varicose veins
Vein “stripping” surgery after 2000
95 Limbs
Patients with
one limb
Patients with
two limbs
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4. Patient Demographics and Clinical Characteristics
Patients with Varicose Veins – Despite Prior Surgery
• 49.4 years (range, 32-74)
• 84% female
• Surgery occurred median of 7 years previously (1-12 yrs)
• Deep venous insufficiency: 10/95 limbs (11 %)
95 Limbs
Patients with
one limb
Patients with
two limbs
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5. Clinical Distribution: C Classification
72% are C2 and C3
45
44
40
35
30
24
25
19
20
15
10
5
5
3
0
0
C2
C3
C 4a
C4b
C5
C6
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6. Presence of varicose veins despite surgery
VV associated with saphenous veins, perforator veins or accessory veins
Segmental or Fully
Intact GSV
Perforator vein(s)
61 (64%)
Accessory vein reflux
28 (30%)
26 (27%)
37 segmental
24 intact
21 thigh
16 calf
Small saphenous vein reflux
20 (21 %)
Neovascularization/pelvic veins
12 (13 %)
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7. Treatment of patients with recurrent varicose veins
95 Limbs
Patients with
one limb
% Patients
Microphlebectomy
7%
20%
Foam
73%
Plus
received
concurrent
adjunctive
treatment
Foam & Microphleb.
Second vein treated in
23 cases
Complete Treatment Received
69 Treated with EVLA
Patients with
two limbs
26 EVLA not possible
7%
46%
Received
treatment
46%
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8. Follow-up of EVLA-treated saphenous veins
Majority of patients reported symptomatic improvement
80
70
69 69
60
53 53
EVLA treated
50
39 38
40
Total occlusion
30
23 23
20
14
14
10
0
2
0
1 week
"Foam" other
refluxing veins
3 months
6 months
(Superficial venous
insufficiency –
excluding SV)
12 months
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9. Summary
1. EVLA is feasible in many patients with recurrent
varicose veins and prior saphenous vein surgery.
2. EVLA is effective in suitable patients in the
retreatment of residual saphenous veins, or refluxing
saphenous veins in limbs with prior surgery.
3. The majority of EVLA-retreated patients reported
symptomatic improvement.
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