VARICI RECIDIVE DAL 6% ALL`80% ? REZIDIVVARICOSIS von 6% bis 80% ? RECURRENT VARICOSE VEINS FROM 6% TO 80% ? Ebner H*, JA Ebner** * SVGTCHIR, ** CHIRURGIA

VARICI RECIDIVE DAL 6% ALL`80% ?

REZIDIVVARICOSIS von 6% bis 80% ?

RECURRENT VARICOSE VEINS FROM 6% TO 80% ?

Ebner H*, JA Ebner**

* SVGTCHIR, ** CHIRURGIA VASCOLARE E TORACICA Ospedale Centrale Bolzano

author year recurrence rate Time F-up

Jones L 1996 7 - 65% prolonged

Perrin MR 2000 20 - 80% 5 – 20y

Blomgren L 2004 20 - 60% not mentioned

Kostas T 2004 20 - 80% not mentioned

Egan B 2006 20 - 70% x – 10y

Noppeney T 2009 6 - 60% not mentioned

Parès JO 2010 8 - 80% not mentioned

Gad M 2012 20 - 60% 5y

Recurrence Rates in the Literature

Recurrent varicose veins from 6% to 80% ?

Recurrence Rates in the Literature


Jones L 1996


author year percentage F-up

Leu HJ 1968 6,5 % 3y

Jeanneret C et al. 1999 24,4 % 6y

Fischer R et al. 2000 60,0 % 34y

The Incidence depends on

Time of F-up



Diagnostic Methods

Diagn. Method % Recurrence

Questionnaire 36%

Clinical Examination 47%

Duplex 60%

Fischer R et al. Phlebologie 2000;29:17-22

Fischer R: 125 legs after 34 years



Diagnostic Methods

Author // Diagn. Method

YearsF-up

Sympto-matic

Clinical examination Duplex Specifi-

cationsIndication

for intervention

Jones L 1996 2y 11% 43% 52%

Fischer R 2000 34y 36% 47% 60% 22%

Recek C 2000 4y 16% 68,5% 81,5% GSV stem 8,6%

Blomgren L 2004 8y 68% 86% 57% 57% groin 27%

Parès J 2010 5y ? 50% 65% 22,2%


The Incidence depends onChoosen Parameters:

1) Clinical Examination

Hobbs Classification 2:„cure“ :absence of Varicose Veins„improvement“: Varicose Veins < 5mm„failure“: Varicose Veins > 5mm, main trunks or incompetent Perforators

Hobbs JT, Arch Surg 1974; 109:793-796, cited by Parès Ann Surg 2010

Hobbs Classification 1: Hobbs JT, Arch Surg 1974

„cure“ :no varices or symptoms„improvement“: minor residual varices ± symptoms„failure“: no improvment or worsening of varices or symptoms compared to preoperative findings



1) Clinical Examination

Hobbs JT, Lancet 1978; 27:1149, cited by Carandina Eur J Vasc Endovasc Surg 2007

Hobbs Classification 3:Class A: no visible and palpable varicose veinsClass B: a few visible and palpable v.veins < 5mmClass C: remaining or newly formed VV > 5 mmClass D: incompetent main trunks and perforator



Choosen Parameters: 2) Duplex 1

Edinburgh Classification Blomgren L 2004 Reflux on duplex with escape point and change of Compartment Carandina 2007

Fischer`s Classification Fischer R 2000

No precise indications Jones L 1996, Bountouroglou D 06, Faubel 2010,

Obliterated, Competent or Reflux Kalodiki EThe most referrin

g to SFJ



2) Duplex 2

Vvein diameter ≥ 3mm Hartmann 2006, Jones 1996, Faubel 2010, van Rij 2004, 4mm Blomgren 2004,

≥ 5mm Carandina 2007, Frings 1999, Parès 2010, Zamboni 2010

Reflux> 0,5 sec Bountouroglou D 2006, Disselhoff 2011, Escribano 2003, + 7 > 1,0 sec Carradice 2011,

no value Fischer 2000, Carandina 2007, Faubel 2010, Parès 2010

Clinical Significance Perrin „Consensus“ 2000,



Performed Treatment

Therapy % Recurrence Years of F-up authors

No SFJ ligature 82% 3 Zamboni,

SFJ alone 43%,36% 2,10 Jones,Belcaro,

SFJ + stripping AK 20%,47%,25%,8% 1,5,2,2 Carradice,Faubel,Jones,Mooij,

SFJ + stripping BK 35% 5, Kalodiki,

SFJ + strip + perfor. 60%,48%, 34,5 Fischer,Parès,

CHIVA 87%,31%,18,5% 3, Escribano,Parès,Carandina

ASVAL/ESEC not found Not found

Sclerotherapy ± Foam 35%,65%,39% 2,6,5 Shadid,Hobbs,Kalodiki

Endovasc. Laser 4%,38%,25%,44% 1,5,2,10 Carradice,Disselhoff,Mooij,Belcaro

Endovasc. Termal 49%, 5 Disselhoff,



Definition• Recurrent Varices = Varici Recidive

Residual VaricesWhat is „Recurrence“ in Surgery meaning?

Return of the same pathology operated on earlier

What is „Recurrence“ in Flebology meaning?

Presence of varicose veins in a lowerlimb previously operated on for varices

…… and varicose veins still present after the operation?

• Residual Varices

…… and varicose veins in other sides but the operated one?

• Recurrent

TRUE

Perrin M, consensus document 2000

New Varices after Treatm

ent



Criterion some authors

Only clinical Hobbs, Royle, Parès, Rass

Clinical and Duplex Faubel and 12 authors more

Clinical or Duplex Carandina, Carradice, Blomgren

Duplex Fischer, Hofer, Kostas

Duplex and Questionaire Bountouroglou, Darwood, Disselhoff

Duplex and amb.ven.press. Belcaro 1, Belcaro 2

Duplex and Symptomatic Shadid

Assessment for recurrences


Indication for Reintervention ?

Author // Diagn. Method

YearsF-up

Sympto-matic

Clinical examination Duplex Specifi-

cationsIndication

for intervention

Jones L 1996 2y 11% 43% 52% --

Fischer R 2000 34y 36% 47% 60% 22%

Recek C 2000 4y 16% 68,5% 81,5% GSV stem 8,6%

Blomgren L 2004 8y 68% 86% 57% 57% groin 27%

Parès J 2010 5y ? 50% 65% 22,2%



% of Patients Lost

Y F-up % patients lost in F-up

0,40 - 1 0, 0, 15, 45

2 - 5 9, 10, 10, 39, 9, X, 0, 4, 16, 29, 37, 46,

6 - 10 0, 60, X, X, 11, 17,

14 - 34 X, 87


SUMMARYRecurrence rates depend on

Time of Follow upDiagnostic MethodsChoosen ParametersPerformed TreatmentType of Recurrence

Assessment for RecurrencesPercentage of Patients controlled

CONCLUSIONS


Dealing with a bare recurrence rate of varicose veins from 6% to 80% is not

correct, neither for papers nor for lectures

Every recurrence rate has to be supplemented by clear data

concerning at least the mentioned variables

Documents

VARICI RECIDIVE DAL 6% ALL`80% ? REZIDIVVARICOSIS von 6% bis 80% ? RECURRENT VARICOSE VEINS FROM 6% TO 80% ? Ebner H*, JA Ebner** * SVGTCHIR, ** CHIRURGIA