About Recurrent Varicose Veins
1. How often do varicose veins recur?
Some people will develop new varicose veins in the years following treatment regardless of the method used for treatment. This is less likely if your veins are treated by a vein specialist who is able to accurately identify the problem with pre-treatment duplex ultrasound scanning and who has expertise in all available treatments in order to tailor the treatment specifically to you. Currently, about 22% patients sent to hospital with varicose veins has had vein treatment before.
2. Why do varicose veins recur?
There are several reasons why varicose veins may “come back” depending of the type of treatment previously used:-
With surgical treatment, veins may not have been tied off properly. If the junction between the superficial and deep veins is not tied off properly (in the groin or behind the knee), or if smaller branches (tributaries) are left untied in the groin, pressure can build up in the veins lower down the leg resulting in more varicose veins.
Some veins may not actually have been removed. This is why it is important for the surgeon and patient to agree exactly which veins will be removed when the veins are being marked up by the surgeon immediately prior to the operation. If the varicose veins were very extensive or if severe skin changes or leg ulcers were present, removal of every visible varicose vein is not possible.
The long saphenous vein (running in the thigh) may not have been stripped properly. This may increase the chance of further veins developing.
New veins may grow. This occasionally occurs in the groin even after thorough surgery or endovenous treatment.
New varicose veins may develop in a completely different venous system. For example, if veins arising from the groin were previously tied off and stripped (long saphenous system), veins arising from behind the knee (short saphenous system) may subsequently become a problem and vice versa. Veins which connect the superficial and deep vein systems at sites other than the groin or behind the knee (perforating veins) may develop leaky valves and cause further varicose veins.
It is possible for new varicose veins to develop as a result of a problem developing in the deep veins of the leg (deep vein thrombosis). It is important to exclude this possibility by ultrasound scan (duplex) particularly if further surgery is contemplated.
Similar problems apply to other treatment modalities such as Endovenous Thermal Ablation techniques (e.g. Laser and Radiofrequency) and Endovenous Chemical Ablation (e.g. Foam Sclerotherapy). The truncal veins (long or short saphenous) may be incompletely ablated or recanalise after these techniques or varices lower down the leg may persist or recur.
Being overweight, standing for long periods at work and having children may all increase the risk of varicose veins recurring.
Women who suffer from vulval varices during pregnancy or who have evidence of pelvic/ovarian vein reflux (e.g. heaviness and discomfort worse around menstruation; veins coming down the upper inner thigh region) are more likely to suffer from recurrent veins after initially successful treatment.
3. How can recurrent varicose veins be prevented?
There is no way of guaranteeing that veins do not recur following treatment regardless of the technique used. However, it is clear from the above that the risk can be reduced by thorough, accurate surgery or minimally invasive endovenous treatment performed by a specialist and based on the results of pre-operative ultrasound scan (duplex) where appropriate. Simple measures may help to prevent new veins such as regular exercise, maintaining normal weight and wearing support stockings if one’s job involves a lot of standing.
At the Plymouth Vein Clinic we ensure that all patients are followed up in the weeks after treatment and examined clinically and/or by ultrasound to determine that all the relevant veins have been successfully treated and to arrange further treatment if necessary.
4. Treatment of recurrent varicose veins
The need for treatment of recurrent varicose veins may arise due to cosmetic embarrassment or symptoms as for primary varicose veins. The situation is often more complicated than the original problem. Therefore, it is important to consult a specialist who is experienced in dealing with recurrent varicose veins and who has access to ultrasound investigations (duplex scan). The latter is always indicated in cases of recurrent varicose veins and is necessary to determine the feasibility and nature of any further treatment and to exclude the possibility of deep vein thrombosis.
Further treatment is usually possible. Surgery may involve repeating the groin operation and tying off new or residual veins. Due to scar tissue this is often more complicated than the first operation and may be more painful. Also, there is a higher risk of wound complications such as discharge and infection. For these reasons, minimally invasive "non-surgical" treatment such as Foam Sclerotherapy, is particularly desirable for recurrent veins.
If the recurrent veins are small and not particularly extensive, treatment by liquid or foam micro-injection sclerotherapy might be suitable. Local removal of recurrent veins (phlebotomies) is another option.