Varicose veins are a common medical condition where superficial veins, most often in the legs, become enlarged, twisted, and bulging beneath the skin. This occurs because the one-way valves inside the veins become damaged or weakened, allowing blood to pool instead of flowing efficiently back toward the heart. This pooling leads to chronic venous insufficiency, which is the underlying cause of the visible veins. Modern treatment options are highly effective and minimally invasive, including endovenous thermal ablation (using laser or radiofrequency energy), sclerotherapy injections, and microphlebectomy. Patients seek these procedures hoping for a permanent solution to the symptoms and appearance of vein disease.
Understanding Varicose Vein Recurrence
The question of whether varicose veins return after treatment is common, and the reality is that recurrence is possible, a phenomenon often referred to as Recurrent Varicose Veins (RVV). It is important to distinguish between a true recurrence and the progression of the underlying disease. True recurrence involves the failure of the initial treatment, such as a treated vein reopening or new vessels forming near the original treatment site.
The progression of the disease means new varicose veins develop elsewhere due to valve failure in a previously healthy vein. The likelihood of a vein problem returning increases over time, regardless of the initial method used. Clinical data suggests recurrence rates vary widely, generally falling between 13% and 65% over a five-to-ten-year period.
The rate of recurrence is heavily influenced by the specific procedure performed. Some studies comparing methods over a five-year period have shown a lower recurrence rate for conventional surgery compared to endovenous ablation techniques like radiofrequency ablation (RFA). However, other large studies show no significant difference in clinical recurrence rates between modern endovenous techniques and surgery.
Primary Factors Contributing to Recurrence
Varicose veins may reappear due to a combination of technical, biological, and systemic issues. A prominent biological cause is neovascularization, the formation of new, abnormal blood vessels. These fragile, disorganized vessels can sprout from the site of previous surgery, particularly near the saphenofemoral junction in the groin, creating new pathways for blood to flow back down the leg.
Another significant cause is incomplete initial treatment, often classified as a technical error. This occurs when the primary source of venous reflux—the faulty vein—or its associated smaller tributary veins are not fully addressed during the first procedure. If an incompetent vein is missed or only partially closed, it continues to allow backflow, leading to the reappearance of visible varicose veins.
The third main factor is the underlying, progressive nature of chronic venous insufficiency (CVI). Treating a varicose vein removes the symptom, but it does not cure the systemic weakness in the vein walls and valves that caused the problem. Over time, the progressive disease can lead to valve failure in other, previously healthy veins, creating new areas of reflux and new varicose veins.
Long-Term Monitoring and Management
Managing the risk of recurrence begins with a robust post-procedure protocol, starting with regular follow-up appointments. These check-ups frequently involve surveillance with a Doppler ultrasound, a non-invasive scan that maps blood flow in the veins. Ultrasound can detect early signs of reflux, such as the treated vein partially reopening or new problem veins developing, often long before any visible varicosities appear on the skin. Early detection through surveillance allows for minor, targeted intervention before the problem becomes extensive.
Patients are strongly encouraged to adopt lifestyle changes to mitigate the risk of new vein problems forming. Weight management is important, as excess body weight increases pressure on the veins in the legs. Regular physical activity, especially walking, helps the calf muscles pump blood back toward the heart, improving circulation and reducing venous pressure.
Consistent use of medical-grade compression stockings is important for long-term management. These garments apply graduated pressure to the leg, helping to prevent blood from pooling and supporting the venous system against the forces of gravity. If veins do return, treatment is almost always possible and is tailored to the specific cause identified by ultrasound. Common re-treatment options include repeat thermal ablation, focused sclerotherapy injections, or microphlebectomy to remove the new veins.