Groin recurrences after surgical and endovascular treatments of varicose veins in the territory of the greater saphenous vein: a coherent hypothesis to explain their occurrence

Surgical and endovascular procedures to treat varicose veins in the territory of the Greater Saphenous Vein (GSV) are burdened by a variable rate of groin recurrences. In the case of surgical procedures, they are due to the development of tortuous vessels leading to the formation of a cavernoma in the site of the previous Saphenous-Femoral Junction, after crossectomy, or to a by-pass of the metallic clip, after crossotomy. In the case of endovascular procedures, groin recurrences are, instead, mainly represented by rectilinear vessels due to the progression of the incompetence within an antigravitational Sapheno-Femoral Junction (SFJ) tributary, most often the Anterior Saphenous Vein (ASV), and rarely by tortuous vessels leading to the formation of a cavernoma in the distal part of the stump always resulting from the procedure. In this paper we suggest a coherent hypothesis to explain the occurrence of groin recurrences after surgical and endovascular procedures based upon experimental studies and observational data. Recurrences due to pelvic shunts or to incompetent thigh perforator veins, are not considered.