Recurrent varicose veins

Recurrent Varicose Veins

Varicose veins are largely treated by changing the circulatory pattern created by the underlying valvular failure. This frequently involves disconnecting superficial and deep connections that have incompetent valves to stop the flow from high-pressure deep veins back into low-pressure superficial veins.

Because there are numerous connections from superficial to deep veins (perforators) that could potentially fail, recurrence should be less of a surprise than the lack thereof. Good treatment necessitates the identification of these abnormal connections, which requires imaging that both identifies the perforator and demonstrates the abnormal flow. Ablating the damaged superficial veins (varicosities) without identification of these abnormal connections could potentially fail.

Causes of Recurrence

The causes of recurrence have been identified as wrong or inadequate procedures; recanalization of the treated veins; new sources of incompetence, such as an accessory saphenous vein, small saphenous vein (SSV), or perforator vein; pelvic vein incompetence; and neovascularization. Deep venous disease is a recognized risk factor for an increased chance of recurrence, leading to the possibility of obstruction playing a role in recurrence.

Inadequate Procedures

A wrong or inadequate procedure can be a cause of recurrence if Perforators, accessory veins, small saphenous extensions, and pelvic escape points were frequently overlooked. Simply ablating or stripping the great saphenous vein (GSV) and not treating a refluxing accessory saphenous vein will lead to early recurrence.

New Sources Of Incompetence

New sources of incompetence, such as accessory and perforator veins should be treated with phlebectomy and/or chemical ablation (sclerotherapy) ,including Thermal ablation, or ultrasound-Guided ligation.

Recanalized Veins

Recanalized saphenous veins after thermal, chemical, or mechanochemical ablation can be especially challenging to treat. Deploying the right technique to treat widely patent and a scarred vein due to failed previous attempt require clinical expertise and experience. Finally, ligation from the highest refluxing point, such as the saphenofemoral junction or perforator, with or without stripping could be considered if less invasive methods fail. The vein may need to be removed in segments if it is not possible to strip.

Neovascularization(New Vein Formation)

Neovascularization provides a challenge for treatment; the vessels are very thin-walled, usually present in multiples, and grow in scar tissue from a previous treatment. This makes it potentially fraught with complications, including lymphatic injury, bleeding, and infection.

Abdominal And Pelvic Incompetence

Treatment usually requires the initial diagnosis to be made by ultrasound or possibly venography, as well as presenting symptoms. If the symptoms are limited to the lower extremity, then therapy can be limited to treating the escape points from the abdominal wall or pelvic vessel with either direct ligation or image-guided sclerotherapy.

Patients presenting with pelvic symptoms as well as recurrent varicose veins should be evaluated for pelvic reflux and pelvic varicosities. The pelvic symptoms can be ameliorated while also treating the source of the reflux causing the recurrence of the lower extremity symptoms. Contrast venography of the gonadal and internal iliac veins should show the source of reflux and pelvic varicosities. Refluxing veins can be treated with embolization and/or sclerotherapy, ideally ablating the varicosities as well as occluding the refluxing vein.

Obstructive Disease

Recurrent varicose veins are more common in patients with a history of DVT and postthrombotic syndrome, which makes the possibility of deep venous obstruction a possible cause of the recurrent varicosities, especially with more advanced symptoms.

We in our Vein and foot clinic offer treatment for such advanced Venous disease, which could be the cause of increased venous pressures leading to recurrent reflux, varicose veins, affecting quality of life.

Recurrent varicose veins are an inevitable part of treating venous disease.

Despite proper diagnosis and treatment, recurrence is still a problem. The most common sources of recurrence are accessory and perforator veins, neovascularization, and deep venous disease from refluxing abdominal pelvic veins and obstruction. Treatment of these patients can be challenging and requires careful follow-up with duplex ultrasound evaluation and occasionally other imaging modalities.

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Treatments for Recurrent Varicose Veins

Venaseal Glue Treatment

Can be performed in the office/outpatient environment
Is relatively painless?
Very little bruising of the leg
Minimal local anaesthetic required.
Return to work within 24 hours.

Radiofrequency Vein Ablation

Gold standard treatment of varicose veins (along with endovenous laser ablation)
Keyhole treatment
Relatively painless and return to work within 24 hours
Useful in treating primary varicose veins

Closure Treatment

Same day procedure
Fast recovery – resuming normal activities within 1-2 days
Minimal or no scarring

EndoVenous Laser Ablation

Keyhole treatment
All varicose vein sizes can be treated.
Relatively painless with return to work within 24 hours
Useful in treating primary and secondary varicose veins

Ultrasound – Guided Foam Sclerotherapy

Keyhole treatment
Useful in treating recurrent varicose veins
Outpatient/office based treatment
Compliments: laser and radio frequency treatment of varicose veins

Vein Check-up

At the Vein and Foot Clinic, we offer an early detection service for the potential risk of developing thread veins, varicose veins, pelvic varicose veins, and deep vein thrombosis (DVT).

Don’t let vein issues affect your life.

Book a call with us

Recurrent varicose veins