Varicose vein recurrence after endovenous thermal ablation (EVTA) of the great saphenous vein most commonly occurs due to which mechanism?
- A Technical recanalization of the ablated segment
- B Development of thrombophlebitis in perforator veins
- C Neovascularization at the saphenofemoral junction (SFJ) and tributaries not treated at index procedure ✓
- D Failure of compression hosiery compliance postoperatively
Explanation
The commonest cause of varicose vein recurrence after endovenous ablation or surgical ligation is neovascularization at or near the saphenofemoral junction — new, small-caliber vessels that bridge the ligated stump and re-establish reflux. This was historically called 'groin recurrence' after surgical strip-and-ligate. Additional causes include failure to address all incompetent tributaries and perforators at the index procedure. Recanalization of the thermal ablation zone occurs in approximately 5–10% with EVTA but neovascularization remains the dominant mechanism, reported in up to 40% at 5 years after open surgery.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.