Laser- or radiofrequency-based thermal ablation with a success rate better than 95% is currently the proven gold standard for treating common varicose veins. Compared to outdated surgical stripping, it’s quick (30 minutes), painless (with local anesthesia), has no recovery time, is less risky, leaves no scars, is far less costly, and allows immediate return to normal activities. But 95% success also means 5% failure. So how can one improve one’s chances of landing in the success group?
First, let’s define “recurrence.” Varicose veins are an inherited tendency that cannot be cured. That means most affected people will develop additional varicosities over time. However, since expert treatment usually eliminates existing varicosities permanently, the first step to avoid recurrent varicose veins is to obtain expert treatment to ensure you will be dealing with only NEW varicosities, not the same ones already treated.
Assuming you’ve had expert treatment, where do new varicose veins come from? They come from several possible sources below the skin surface other than the treated vein. One source is a separate “accessory’ or “circumflex” vein sharing the same connection in the groin as the treated saphenous vein. Another is an “incompetent perforator vein” which allows the reversal of blood flow from deeper veins to the surface. A third source is “neovascularization,” or the rerouting of blood around the closed saphenous vein in the groin. While experienced doctors can sometimes spot these problems in advance and make allowances for them during treatment, it is not always possible; otherwise we would all have perfect success rates without any recurrences! Fourth, recurrent varicosities commonly come from a previously normal vein which simply took longer to declare itself and show up according to its own evolutionary time-frame.
Finally, a treated vein may simply not fully respond to the standard treatment protocol and either fail to close initially or reopen later (“recanalization”). The take home lesson: there is no cure for varicose veins, which means occasional periodic maintenance treatment will be needed for occasional recurrence. But there is a silver lining. Recurrence of varicose veins after expert treatment occurs infrequently, often after decade or more, but recurrent spider veins are a constant ongoing concern with less predictable and imperfect results. Bet you never thought you’d be thankful you got varicose veins instead of spider veins!