Morphological Structural Changes in the Wall of the Great Saphenous Vein Associated with Recurrent Varicose Veins after Endovenous Laser Coagulation

The aim of the study was to evaluate the degree of morphological changes in the wall of the great saphenous vein (GSV) associated with recurrent varicose veins at different intervals after endovascular laser ablation (EVLA) for varicose veins.

Material and methods. The study included thirty-two patients (20 women and 12 men) with symptomatic recurrent varicose veins treated at S. M. Kirov Military Medical Academy (Advanced Surgical Training Clinic № 1) between 2018 and 2020. They had previously undergone EVLA of the GSV trunk due to its insufficiency and varicose transformation, as well as miniphlebectomy. Twenty-four (75%) patients underwent open reoperation. Segments of the terminal sections of the GSV trunks with a length of 10–40 mm and sections of the GSV in the lower and middle third of the thigh were taken from 24 operated patients for morphological and microscopic analysis. A microscope at 40× to 200× magnification and hematoxylin and eosin staining were used. The histological examination results were evaluated using a semiquantitative analysis technique.

Results. In cases of early recurrence (1–3 months after surgery), focal isolated changes in all layers of the venous wall with signs of incomplete destruction of its tissue structures were detected in 3 patients (12.5%). At later stages (12 patients, 50%), pronounced irreversible changes in the media of the vessel were observed. In cases of varicose vein recurrence and vein recanalization after a period of more than 1 year (9 patients, 37.5%), collagen and elastic fibers at the site of the heat-induced thrombus contained a large amount of hyaline.

Conclusion. An assessment of the degree of structural changes in the vein wall previously treated with laser coagulation revealed that the key reason for the GSV recanalization within the first year after surgery is insufficient energy impact on all layers of the venous vessel.

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