Treatment for varicose veins (VV) is insufficiently evidence based and recurrence rates are high. The aim of this thesis was to study the long-term results after VV surgery, risk factors for recurrences and the effect of preoperative duplex scanning on recurrence rate, quality of life (QoL) and costs.In a follow-up study 89 patients with 100 legs operated on for VV 6–10 years earlier were re-examined with duplex, in 13 cases also with varicography. 57% had incompetent vessels in the groin visible with duplex, equally well defined by varicography. Residual branches could not be differentiated from new vessel formation. The recurrence rate did not correlate to the surgeon’s level of experience or perioperative difficulties at primary surgery.In a prospective randomized study 293 patients (343 legs) were operated on for primary VV with or without preoperative duplex…
Contents
Introduction
Definitions
Anatomy and physiology
Pathophysiology
Epidemiology
Costs
Symptoms, signs and quality of life
Diagnosis
Duplex scanning
Indications for treatment
Treatment options
Surgery
Recurrences after treatment
Aims of the investigation
Patients and methods
Patients
Study design
Paper I
Paper II–V
Duplex scanning
Varicography
Surgery
Quality of life
Cost analysis
Statistics
Ethics
Results
Clinical characteristics of the study populations
Paper I
Paper II–V
Groin anatomy and nature of recurrences
Risk factors for recurrences at primary surgery
Impact of duplex on surgical result
Intention to treat and per protocol
Duplex results after two months
Results after two years
Impact of surgery and duplex on quality of life
Comparison of study patients and reference group
The effect of preoperative duplex
The impact of duplex on costs
Cost analysis
Changes in patterns of venous reflux after varicose vein surgery
Perforating vein incompetence
The saphenofemoral and saphenopopliteal junctions
Remnant great saphenous vein
Deep veins
Discussion
Long-term results after surgery for varicose veins
Safety and surgical results
Quality of life
The discrepancy between surgical results and patient satisfaction
Possible risk factors for recurrences
Inadequate preoperative investigations
Inadequate surgical technique and perioperative difficulties
Neovascularisation
Perforating vein incompetence
Remnant great saphenous vein
Postoperative changes and natural progression of disease
Costs for varicose vein treatment and priorities in the health care system
Gender differences
Should all patients with varicose veins be examined with duplex preoperatively?
Conclusions
Critical issues in research and treatment
Acknowledgements
Summary in Swedish
References
Author: Blomgren, Lena
Source: Uppsala University Library
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