Endovenous Approach to Recurrent Varicose Veins

Historical Background

Recurrence rates of varicose veins of 20% are common, with rates as high as 70% at 10 years. Up to 25% of procedures for varicose veins are performed for recurrent disease, thus placing considerable demands on health care resources. Note that recurrent varicose vein surgery carries a much greater morbidity risk to the patient than primary surgery. This risk seems to be reduced with endovenous techniques.

Etiology and Natural History of Disease

Patients who have had previous high ligation and stripping (HL/S) typically present with recurrent varicose veins; anatomic distribution of these veins is variable. Neovascularization is commonly seen following traditional stripping procedures and is thought to be secondary to “frustrated” venous drainage from the abdominal wall and perineum. Regardless of the mechanism, the result is recurrent reflux in the thigh or lower leg veins.

Multiple factors contribute in the development of recurrent disease. The weight of each factor has not yet been determined because there are no prospective studies with adequate sample size. The following descriptions are common etiologies seen at Miami Vein Center after clinical and color flow duplex imaging (CFDI) examinations are performed in patients presenting with recurrent varicose veins.