Table of Contents
Varicose vein surgery, while helpful in reducing the appearance and symptoms of varicose veins, can have a significant complication: neovascularity.
In some cases, primitive blood vessels may form within the upper thigh area or groin without valves – resulting in immediate recurrence of varicose veins.
Predicting and Preventing Varicose Vein Recurrence
Evaluating the data to better predict and prevent varicose vein recurrence.
Varicose veins are a persistent problem for those with chronic venous disease. While there have been improvements in diagnosis and therapies, the rates of recurrence after treatment can be as high as 80%.
One review found no difference in reflux recurrence between ablative surgery and endovenous treatments, while another study suggests laser ablation is better than surgical removal at one-year follow up. However, long-term analysis still needs to compare these different techniques more closely.
It can be hard to figure out what causes chronic venous disease to return. There are three types of recurrence:
1) Veins not treated in the procedure
2) Veins beginning to reflux one month after a procedure
3) New veins developing in an area where there were no vessels before.
At first, it was thought that recurrence (when veins come back) was caused by surgery that wasn’t done correctly, like when the surgeon did not remove all the problematic veins. But now we know that even if the surgeon does everything right and chooses a good treatment, there can still be recurrence.
This can happen because of new blood vessels growing in the area where the surgery happened, which means there are weak walls and no valves to control them. Even though this happens more often after surgery than with other treatments, it causes similar rates of recurrence in both types of treatments.
Doctors need to understand the difference between neovascularization, which is when new blood vessels form, and vascular remodelling, which is when existing blood vessels grow wider. They also need to know that venous reflux (when there’s too much backflow in the veins) can lead to bad outcomes. But not all reflux causes problems for patients. Doctors must try to predict and prevent recurrence in order to help their patients.
It is not an easy task to predict and prevent recurrence, but the evidence suggests that there are some fundamentals that can guide the approach that is taken in everyday practise and in future research.
Venous disease progression
Venous disease can come back after treatment. This means that the veins may be weaker than before and can cause infections. Some people have vein issues their whole life. It is important to check the veins of these patients after their surgery to make sure they are OK.
When vein problems start, they can get worse quickly. This happens when the veins become inflamed and more white blood cells come to the area. This causes damage to the walls and valves of the veins, increases pressure in them, and makes it worse.
There is no way to stop varicose veins from developing, but some things that can make them worse can be changed. Without treatment, varicose veins will usually get worse.
Treatment of varicose veins early on can help reduce the symptoms and make people feel better. Even if you treat them, they may come back again.
To help prevent varicose veins from getting worse, it’s important to understand what causes them and learn how to lower your risk of getting more serious problems later on.
New Blood Vessels Have Grown or Healed Since Treatment
After an injury, your body will start to heal and make new cells.
This can undo the results of any surgery you had. Varicose veins might come back when new blood vessels form. It is possible to treat varicose veins and open up a different vein to provide blood flow.
Generally, this treatment has low risks of making more blood vessels or reopening closed ones. A vein doctor/phlebologist can help you understand all your options.
What causes recurrent varicose veins?
Varices of varices are brought on by a reflux that was not treated during surgical procedures, most notably those that were performed at the saphenofemoral junction. The symptoms are frequently a progression of the illness or the onset of new reflux.
There are three primary factors that contribute to the recurrence of varicose veins following treatment for the condition. These include:
Unfortunately, the incorrect veins were treated.
Although the appropriate veins were treated, the methods used were inappropriate.
Because more valves are failing, new varicose veins have developed.
The wrong veins were treated
Varicose veins that you can see are not the cause of varicose vein problems. They are caused by deeper veins with no valves. Since the 1980s, we have been able to use a technology called duplex ultrasound scanning to learn more about varicose veins and find out what was wrong with the old understanding.
Varicose veins can be caused by more than just two veins. The anterior accessory saphenous vein, pelvic varicose veins, and other abnormal veins may cause them too. It might even be a combination of all these different veins. Each person’s pattern of disease is different so it is important to get an ultrasound scan from a specialist who knows how to look for all these things. This will make sure that the right treatment happens. It should not come as a surprise that many of the underlying causes of varicose veins are missed by the majority of vein clinics because the scans that are performed typically only last a couple of minutes and are frequently carried out by the same doctor who treats the veins themselves. In these kinds of clinics, doctors frequently base their search for the primary cause of varicose veins on an outdated conception of the condition.
For good varicose vein surgery, it is very important to get a duplex ultrasound scan. This will help figure out which veins are causing the problem. Don’t waste money on cheap or free scans that don’t work. If you don’t use the right scan, it can result in having to do varicose vein surgery again and again.
The Right Veins Were Treated But With The Wrong Techniques
When you have surgery, it usually means that a part of your body is removed and will not grow back. This is true for most parts of the body, like gallbladders. But veins are different – they can repair themselves after damage.
Therefore, when you have varicose veins removed, your body is unaware that a surgeon wants them permanently removed from your body. Your body is the only thing that knows there was an injury, and because of this, it will try to grow the connective tissue, including the veins, back again naturally.
When veins are injured, they do not grow back with valves in them. This means that if varicose veins are removed, new ones will grow without valves. This happens because the old veins were taken off the body’s surface. Even though there is a better way to treat varicose veins called endovenous thermal ablation, some people still use an older method called stripping.
Endovenous thermoablation is a term that refers to different procedures like radiofrequency ablation and endovenous laser ablation. It costs more for the branded methods because those have been researched and developed more. There are many different methods, so there is a wide range of prices.
Sometimes we see patients from other places who think their veins were treated, but when we scan them, the veins are still there. It is not clear if this happened because of the device used or because of how it was used. In many cases, people thought their treatment worked, but then later found out that the veins came back.
Ultrasound-guided foam sclerotherapy is the best way to treat veins, but it does not work as well for bigger veins. To make sure that the best treatment is given to you, The Whiteley Protocol® was created. This protocol helps doctors use ultrasound scanning and give you the right treatment for your veins.
New Varicose Veins Formed Due To More Valves Failing
Varicose veins can come back after treatment. This kind of varicose veins is called “de novo” varicose veins or “disease progression”. It is like this: Imagine you ask 100 people in your town if they have varicose veins. None of them did. But if you check again after one year, some people will have it.
Varicose veins can get worse over time or form new veins in other parts of the leg. People who had treatment for varicose veins have a 3-4.5% risk of getting new varicose veins each year. The best treatments should keep this rate at 3.5-5%. It is not possible to make it any lower than the natural rate of forming new varicose veins over time.
Do varicose veins come back after stripping?
When many patients have surgery to remove many varicoses, the procedure typically yields excellent results for the patients, but occasionally the varicoses come back.
It is estimated that approximately sixty percent of patients will still have varicose veins after treatment, which can be very frustrating for patients.
Patients who have varicose vein surgery have the reasonable expectation that their veins will be repaired successfully because they have undergone the appropriate procedure and been treated with the appropriate procedures.
On the other hand, it is a widely held belief that varicose veins will inevitably reappear at some point. If this is the case, then it appears there is a problem with varicose vein surgery. Alternately, it is possible that varicose veins are unique in that they will always return again regardless of the treatment used.
How do you stop recurrence of varicose veins?
It’s important to wear compression socks after treatment for varicose veins. It will help reduce the chance of the veins coming back. When you stand, your legs should be raised up. Make sure to pay attention to details when trying to prevent recurrence. Studies show that about 50% of cases come back in the saphenofemoral junction area, so make sure ligation is done flush on the femoral side and avoid long femoral stumps.
Finally, to prevent recurrence, it is important to look closely at the veins in the pelvis. This can help detect any refluxes that could cause the same problem after treating the veins in your legs. Refluxes are responsible for up to 17% of recurrences. It is important to check for refluxes early and get treatment based on your body and how blood flows through you.
Predicting Varicose Vein Recurrence of varicose veins after the stripping
Chronic obstruction due to DVT or vein clot, as well as reflux of the deep veins, can be a significant contributor to chronic venous disease and should be taken into consideration as a potential trigger for recurrence in cases where the condition has previously been diagnosed.
The severity of primary vein problem has been shown to have a significant correlation with valve malfunction of the deep veins.
It has been determined that a body mass index (BMI) of more than 30 kg/m2 is one of the potential risk factors for surgical recurrence.
On the other hand, recurrence rates were not significantly different when taking into account factors such as gender, age, the level of experience of the interventionalist, perioperative difficulties (such as bleeding and technical problems), and postoperative complications (such as haematoma, thrombophlebitis, infection, and lymph exudate) following surgical intervention.
Summary
In the management of modern lower limb chronic venous disease, one of the most difficult challenges is predicting and preventing the recurrence of varicose veins.
There are already some studies about how to treat venous reflux, but the criteria for those studies were different. So it’s hard to compare them. Newer studies show that if you take an ablative approach (remove the vein) or a haemodynamic approach (keep the vein and just change how it works) it does not matter if you use surgery or endovenous devices. Taking a hemodynamic approach helps reduce the risk of recurrence. This shows that there is a difference between strategies and techniques used in treating venous reflux.
When treating varicose veins, it is important to do a preoperative check of the body’s blood flow and the iliofemoral and pelvic network. This will help reduce the chance of varicose veins coming back after treatment. Research should look deeper into why varicose veins return, so we can develop better ways to treat them. Sometimes, certain anatomical variations, like double short saphenous or deep venous thrombosis, can cause them to come back.
Different body shapes and sizes can cause a problem to come back. But, most of the time, if you don’t do the surgery correctly, it will come back. Many people have studied this problem, and all of them say that if you don’t do a good job on the surgery in the first place, then it’s likely that it will come back. This is a preventable problem if you just do your best on the initial operation.
Research shows that the highest rate of varicose veins returning was when surgery was not done properly or neovascularization happened. Other studies also found this to be true. Another study recently found that if the first surgery is done wrong or the disease gets worse, then varicose veins can come back. This finding was just released. But, even if there is neovascularization, it will not cause varicose veins to return.
REFERENCES
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3289490
https://jamanetwork.com/journals/jamasurgery/fullarticle/571319
https://clinicaltrials.gov/ct2/show/NCT05693350
