الفهرس 
ANATOMY OF VEINS OF LOWEROnly 14 pages are availabe for public view
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Abstract
We tried in this essay to study the problem of recurrence of varicose veins after surgical treatment; we tried in this work to focus on the causes and management of such a recurrence.
We started by a brief review of anatomy of veins of the lower limb, and the most common variations that surgeons could face in their operations. Then we had to discuss the pathophysiology of varicose veins and the pathophysiology and causes of recurrence.
For many years surgical fault was assumed to be the first and only cause of recurrence. But many studies later discovered that there is incidence of recurrence even with successful surgical techniques this led many investigators to try to find another cause of recurrence.
Many studies attributed recurrence to:
• Neovascularization which is the most important cause of recurrence.
• Non saphenofemoral reflux (Pudendal reflux or epigastric reflux).
• Incompetent perforating veins.
• Lateral accessory saphenous vein.
• Saphenopopliteal recurrence due to:
- ligation of saphenopopliteal junction too far away from the popliteal vein (long stump).
- Insufficient excision of an incompetent saphenous trunk.
After all of this there is still debate on causes of recurrence of varicose veins after surgery.
The symptoms of this recurrence are simply the reappearance of new varicosity in the same site of the operation.
We depend in diagnosis on the same tools as in primary varicose veins, especially:
- Duplex.
- Venography and Varicography.
And we should examine the deep system by duplex and discending phlebography.
Treatment of such recurrence depends on many factors as site, size of recurrence and condition of the patient, and it consists of many procedures such as:
• Re-exploration of the sapheno-femoral junction.
• Injection sclerotherapy.
• Stab avulsion of the recurrent veins.
But still the best is to avoid recurrence, many trials of prevention of this recurrence was done trying to prevent neovascularization for example:
• Natural barriers (e.g.: pectineus flap).
• Artificial barriers (e.g.: silicon, p.T.F.e).
Know the hope is in the new minimal invasive techniques in treatment of varicose veins as:
1. Radio frequency ablation.
2. Laser ablation.