Reoperation for recurrent saphenofemoral incompetence: a prospective randomised trial using a reflected flap of pectineus fascia

Eur J Vasc Endovasc Surg. 1999 Dec;18(6):494-8. doi: 10.1053/ejvs.1999.0906.


Objective and design: in 1978 Sheppard described using a flap of pectineus fascia in an attempt to reduce the further development of neovascularised veins at the saphenofemoral junction. The perceived benefits of this manoeuvre have not been tested by a prospective randomised trial.

Materials and methods: consecutive patients with symptomatic recurrent varicose veins referred to a single consultant were examined for evidence of further reflux from the saphenofemoral junction. This was subsequently confirmed in forty limbs (thirty-seven patients) by descending venography. All had features of a neovascularised segment. These patients were treated by complete exposure and ligation of the recurrences arising from the common femoral vein, with or without the placement of a flap of pectineus fascia (prospectively randomised). The patients were assessed a minimum of eighteen months later by both clinical examination and duplex ultrasound scanning.

Results: six patients were lost to follow-up. This left seventeen limbs remaining in each half of the study. The characteristics in each group were broadly matched.

Conclusions: this study failed to demonstrate any apparent benefit from the application of a flap of pectineus fascia. Most patients showed evidence of re-recurrence arising from the common femoral vein.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Anastomosis, Surgical / methods
  • Fascia / blood supply
  • Fascia / transplantation*
  • Female
  • Femoral Vein / surgery*
  • Humans
  • Leg / blood supply*
  • Leg / diagnostic imaging
  • Male
  • Middle Aged
  • Neovascularization, Physiologic
  • Phlebography
  • Prospective Studies
  • Prosthesis Failure
  • Recurrence
  • Reoperation
  • Saphenous Vein / surgery*
  • Surgical Flaps*
  • Ultrasonography, Doppler, Duplex
  • Varicose Veins / diagnostic imaging
  • Varicose Veins / surgery*
  • Vascular Surgical Procedures*