Phlebography in the Management of Recurrent Varicose Veins

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Abstract
Objectives: (1) To report the results of phlebography (varicography and venography) in the identification of important venous communications in patients with reurrent varicose veins. (2) To assess whether phlebography provides additional valuable information when compared with clinical and hand-held Doppler examination. Design: Retrospective review. Setting: Vascular unit, district general hospital. Patients: A consecutive series of 46 patients attending with recurrent varicose veins. Interventions: Clinical examination, hand-held Doppler, venography and varicography. Main outcome measures: (1) Sites of incompetent venous communications. (2) Assessment of value of preoperative phlebography when compared with clinical and hand-held Doppler examination. Results: Sixty-four venograms were performed on 46 patients of mean age 52 years, range 30–81 years. Calf perforator (88%) and mid-thigh perforator incompetence (38%) were common. Groin recurrence (33%) included examples of neovascularization, inadequate previous surgery and inadequate assessment. Popliteal recurrence (34%) secondary to incompetent gastrocnemius, popliteal fossa and short saphenous veins also present. Preoperative phlebography supplied valuable additional information in 75% of Patients. Conclusion: Phlebography of recurrent varicose veins provides useful information supplementary to that furnished from clinical examination alone.