Can Varicose Veins Come Back After Treatment?

Why do varicose veins come back?

Four mechanisms account for nearly all recurrence, and they are worth separating because they have different implications.

• Progression of disease. The tendency of vein valves to fail is lifelong. A vein that was healthy at the time of treatment can begin to reflux years later. This is the most common cause and is not a failure of the original treatment.
• Neovascularisation. After stripping surgery in particular, small new veins can grow at the groin where the vein was tied, reconnecting the deep and superficial systems. This is one reason keyhole methods, which leave the groin untouched, largely replaced stripping.
• Incomplete treatment. If a refluxing vein, a perforator or a second saphenous trunk was missed on the original scan, or deliberately left, it can enlarge over time. Thorough mapping before treatment reduces this.
• Recanalisation. Occasionally a vein closed by heat, glue or foam reopens. This is uncommon after thermal ablation and glue in published series and somewhat more frequent after foam, which is why foam is often planned as a course rather than a single session.

How often does it happen?

Figures depend on how recurrence is defined, which treatment was used and how long people are followed. Randomised trials with five-year follow-up report that the treated great saphenous vein remains closed in the large majority of people after radiofrequency, laser or surgery, with foam sclerotherapy showing lower closure rates and more re-treatment. When recurrence is defined as any new visible varicose vein, rates rise with time whatever the method, with long-term studies reporting new veins in a substantial minority of people at ten years. The honest summary is that the treated vein very rarely comes back, but new veins elsewhere in the leg are reasonably common over a lifetime, and some people will want a touch-up treatment at some point.

What reduces the risk?

• A complete scan before treatment, with you standing, mapping both saphenous trunks, the perforators and the deep veins, so that nothing significant is missed.
• Treating the source, not just the branches. Closing the refluxing trunk removes the pressure that would otherwise create new tributaries.
• Treating the tributaries at the same time. Trial evidence shows that microphlebectomy or foam for visible veins at the time of trunk ablation reduces the need for later procedures.
• Choosing the method to suit the vein. A very large trunk, a tortuous vein or a vein close to the skin each favour a different approach; see laser, radiofrequency or glue? and the treatment options page.
• A check scan at around six weeks, which confirms closure and picks up any segment that needs a touch-up while it is small.
• Keeping active, managing weight and wearing compression on long days standing, which reduce venous pressure, although none of these can stop valves failing altogether.

What should I do if symptoms return?

Do not assume the original treatment has failed, and do not assume the new veins are the same as the old ones. Arrange a duplex ultrasound. It will show whether the treated vein is still closed, where the new reflux is coming from and whether the deep veins are healthy. Recurrent veins are usually smaller and more tortuous than the original ones, and are most often treated with ultrasound-guided foam sclerotherapy or microphlebectomy under local anaesthetic, without needing to repeat the original procedure. If a previously untreated trunk is now refluxing, it is treated in the same way as the first one was. Treatment of recurrent veins is generally claimable in the same way as the original treatment when symptoms or skin changes are present.

What if I was treated somewhere else?

Recurrence after treatment elsewhere, in Singapore or overseas, is assessed in exactly the same way. It helps to bring the original scan report and procedure note if you have them, but a new scan is done regardless, because the anatomy will have changed. There is no need to return to the original clinic unless you wish to.

Common questions about varicose veins coming back

Does the treated vein grow back?

A vein closed by heat or glue is absorbed by the body over months and does not regrow. A vein removed by stripping or microphlebectomy is gone. What can happen is that a closed vein reopens, which is uncommon, or that neighbouring veins take over the reflux, which is the usual form of recurrence.

Which treatment has the lowest recurrence?

Radiofrequency, laser and surgery show broadly similar long-term results for the treated trunk in randomised trials; foam sclerotherapy has a higher rate of reopening and re-treatment. Glue has high closure rates in published series, with shorter follow-up because the method is newer. The surgeon's planning and the completeness of the first treatment matter at least as much as the device.

How soon after treatment could veins come back?

New visible veins within the first year are usually veins that were present but small at the time of treatment, or a segment that did not close fully. Veins appearing after several years are more likely to be new disease. Both are assessed and treated in the same way.

Will I need treatment again and again?

Most people need at most an occasional touch-up over their lifetime, typically foam injections under local anaesthetic. A small number with a strong tendency to vein disease need more. A planned check scan every few years, or whenever symptoms change, keeps any new problem small.