Overlooked and neglected aspects in the management of recurrent lower extremity venous insufficiency: Unveiling the significance of the lymphatic venous network

Background This study examines the role of the inguinal lymph node venous network (LNVN) in recurrent varicose veins. Methods Seventy-five patients with recurrent varicose veins were assessed using color Doppler ultrasound and dynamic lymph node venography. Primary outcomes included LNVN reflux identification, and secondary outcomes analyzed recurrence rates and associations with venous pathology. Results LNVN involvement was detected in 41.3% of cases, significantly correlating with shorter recurrence-free intervals (median: 8 months vs 12 months, p = 0.04). Coexisting risk factors included neovascularization (18.2%), incomplete treatment (25%), and inadequate surgical technique (13.6%). Conclusion LNVN reflux is a significant contributor to varicose vein recurrence, with distinct imaging features that should be integrated into routine diagnostic protocols. Further research is needed to establish standardized diagnostic criteria and optimize management strategies.