VARICI RECIDIVE DAL 6% ALL`80% ?

1. VARICI RECIDIVE DAL 6% ALL`80% ? REZIDIVVARICOSIS von 6% bis 80% ? RECURRENT VARICOSE VEINS FROM 6% TO 80% ? Ebner H*, JA Ebner** * SVGTCHIR,** CHIRURGIA VASCOLARE E TORACICA OspedaleCentraleBolzano

2. Recurrentvaricoseveinsfrom 6% to 80% ? Recurrence Rates in theLiterature

3. Recurrentvaricoseveinsfrom 6% to 80% ? Recurrence Rates in theLiterature Jones L 1996

4. Recurrentvaricoseveinsfrom 6% to 80% ? The Incidencedepends on Time of F-up

5. Recurrentvaricoseveinsfrom 6% to 80% ? The Incidencedepends on DiagnosticMethods Fischer R: 125 legs after 34 years Fischer R et al. Phlebologie 2000;29:17-22

6. Recurrentvaricoseveinsfrom 6% to 80% ? The Incidencedepends on DiagnosticMethods

7. Recurrentvaricoseveinsfrom 6% to 80% ? The Incidencedepends on Choosen Parameters: 1) Clinical Examination HobbsClassification 1: Hobbs JT, ArchSurg 1974 „cure“ :novaricesorsymptoms „improvement“: minor residual varices ± symptoms „failure“: noimprovmentorworseningofvarices orsymptomscomparedtopreoperativefindings HobbsClassification 2: „cure“ :absenceofVaricoseVeins „improvement“: VaricoseVeins < 5mm „failure“: VaricoseVeins > 5mm, maintrunksorincompetent Perforators Hobbs JT, ArchSurg 1974; 109:793-796, citedbyParès Ann Surg 2010

8. Recurrentvaricoseveinsfrom 6% to 80% ? The Incidencedepends on Choosen Parameters: 1) Clinical Examination HobbsClassification 3: Class A: novisibleand palpable varicoseveins Class B: a fewvisibleand palpable v.veins < 5mm Class C: remainingornewlyformed VV > 5 mm Class D: incompetentmaintrunksandperforator Hobbs JT, Lancet 1978; 27:1149, citedbyCarandinaEur J VascEndovascSurg 2007

9. Recurrentvaricoseveinsfrom 6% to 80% ? The Incidencedepends on Choosen Parameters: 2) Duplex 1 Edinburgh ClassificationBlomgren L 2004 Reflux on duplexwithescapepoint andchangeofCompartmentCarandina 2007 The mostreferring to SFJ Fischer`sClassificationFischer R 2000 NopreciseindicationsJones L 1996, Bountouroglou D 06, Faubel 2010, Obliterated, Competentor Reflux Kalodiki E

10. Recurrentvaricoseveinsfrom 6% to 80% ? The Incidencedepends on Choosen Parameters: 2) Duplex 2 Vveindiameter ≥ 3mm Hartmann 2006, Jones 1996, Faubel 2010, van Rij 2004, 4mm Blomgren 2004, ≥ 5mm Carandina2007, Frings 1999, Parès 2010, Zamboni 2010 Reflux > 0,5 sec Bountouroglou D 2006, Disselhoff 2011, Escribano 2003, + 7 > 1,0 sec Carradice 2011, novalueFischer 2000, Carandina 2007, Faubel 2010, Parès2010 Clinical SignificancePerrin „Consensus“ 2000,

11. Recurrentvaricoseveinsfrom 6% to 80% ? The Incidencedepends on Performed Treatment

12. Recurrentvaricoseveinsfrom 6% to 80% ? The Incidencedepends on Definition TRUE • RecurrentVarices = VariciRecidive Whatis „Recurrence“ in Surgerymeaning? New Varicesafter Treatment Residual Varices Whatis „Recurrence“ in Flebologymeaning? Return ofthe same pathology operated on earlier Presence ofvaricoseveins in a lower limbpreviouslyoperated on forvarices Perrin M, consensusdocument 2000 • Residual • Varices …… andvaricoseveins still present after theoperation? • Recurrent …… andvaricoseveins in othersides but theoperatedone?

13. Recurrentvaricoseveinsfrom 6% to 80% ? The Incidencedepends on Assessment forrecurrences

14. Recurrentvaricoseveinsfrom 6% to 80% ? IndicationforReintervention ?

15. Recurrentvaricoseveinsfrom 6% to 80% ? The Incidencedepends on % ofPatients Lost

16. Recurrentvaricoseveinsfrom 6% to 80% ? SUMMARY Recurrenceratesdepend on Time of Follow up DiagnosticMethods Choosen Parameters PerformedTreatment Type ofRecurrence Assessment forRecurrences PercentageofPatientscontrolled

17. Recurrentvaricoseveinsfrom 6% to 80% ? CONCLUSIONS Dealingwith a bare recurrence rate ofvaricoseveinsfrom 6% to 80% is not correct, neitherforpapersnorforlectures Every recurrence rate hastobesupplementedbycleardataconcerningat least thementioned variables