[Ultrasonographic exploration for recurrent varicose veins in the popliteal fossa after surgery].

Recurrence rate, five years after surgery is known to be high, about 50%, further reoperations amount a quarter of global venous insufficiency surgery. True varicose veins recurrence has a very theoretical definition which is reappearance of the disease after initial total eradication. Early post surgical recurrence result from an incomplete or inadequate operation. Late recurrence is known to occur after correct surgery but with deterioration of the remaining superficial venous system and with evolving point of reflux, or in case of inappropriate surgery leaving communication between superficial and deep venous systems which have evolved silently, or even recurrence following incomplete surgery because of unrecognised anatomical variation. This distinction is merely theoretical, duplex-scan shows that incomplete removal of varicose veins remain the main cause of recurrence. In presence of post-surgical varicose vein recurrence, the aim of sonographic investigation is to identify the main factors, more than the cause, before surgery assessment which could serve as reference being seldom available. In practice certain technical or and tactical errors could surely be identified in the course of treatment, without being able to assess precisely what could be attributed to the evolution of the varicose disease itself. Sonographic tests enables dynamic mapping of recurrence and allows for a better choice of further treatment, surgery, phlebectomy, sclerotherapy, or various techniques combined, or even abstaining from any aggressive therapy if even slightly risky. Ideally this mapping should be followed by skin marking when further surgery is necessary to avoid yet more incomplete treatment.