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Abstract
Varicose veins represent everything n’Onl a cosmetic to a risk of venous leg ulcers. Predicting the risk of COlllpl ications has been difficult, not least due to less than satisfactory diagnostic procedures. Recent invistigations have pointed some
l important new concepts: superficial venous inCOtllpetence nlay give rise to an ulcer, and such an ulcer may be prevented by varicose vein surgery.
Clinical diagnosis is never sufficient in cases of sllspected chronic venous ineornpetence. The InininlUlTI requirenlentis the use of a hand-held Doppler. OnenIy, a lllore detailed ultrasonographic analysis is required.
Recurrence rates as high as 65°;() have been reported following surgery for prinlary unconlpl icated varicose veins. In 1110St cases the recurrence have been I inked to inappropriate or inadequate surgery 111 the first instance. Traditionally, preoperative assessnlent of prinlary varicose veins has included a clinical exanlination. However, this has clearly been demonstrated to be unreliable, with high clinical uncertainty rates. Recently, clinical accuracy has inlproved with the adj uncti ve use of the continuous wave fOrIll hand-held Doppler.
However, this 1110dality remains inaccurate due to the inability to confidently identify the vessel being insonated. Therefore a reduction in recurrence rate would represent a tnajor saving for national health service. This study evaluated the ill1portance of preoperative duplex scanning In all patients with primary uncomplicated varicose veins by Clssessing the radiological incidence of saphenofenloral (SF J), sapheno-popl iteal (SPJ), Th igh perforators and cal r perforators i ncornpetence. I n add ition, any significant anatomical variations that would have been inlpossible or difficult to detect clinically or with I-lHD and which lnight contribute to recurrences were also invistigaled.
Clinical and Doppler assessnlent is unreliable