La néovascularisation post chirurgicale est-elle une fatalité ? Quelle est la responsabilité du chirurgien ?

Abstract

Vascular endothelial growth factor, inflammatory process, hypertrophy of pre-existant vessels (lymph node veins),
haematomas revascularisation, and high difference in pressure are the different causes of neovascularisation. The latter 3 only depend directly on the way the operation is performed hence on the surgeon.
Concerning the primary varices patch saphenoplasty
does not abolish neovascularisation. It is of first importance
to perform a flush ligation only if necessary (incontinent
terminal and pre-terminal valves). In that case an incision
as small as possible must be carried out with minimal dissection and with tumescence to limit the bleeding and
hematomas. Endovascular technique must be preferred
when the terminal valve is competent.
Concerning re-do it is mandatory to avoid useless re-do,
the best choice is foam sclerotherapy. Neovascularisation
are produced by the complications which are induced by a
large dissection. The barrier techniques are, probably, not as
useful as we was told 10 years ago. The lack of aggressiveness during the operation is certainly far more important:
“Doing less in the groin to do better for the recurrence and
re-recurrence”.