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Common Question: Will My Varicose Veins Come Back After Treatment?

A patient who was treated more than a decade ago with Ambulatory Phlebectomy for a large bulging varicose vein recently came back for a consultation because his symptoms had been resurfacing. After in-depth ultrasound diagnostics, it was evident that he did indeed have venous disease in a large vein running the length of his calf.

“But didn’t you take care of this the last time I was here?” he asked. “Why did it come back? Didn’t you get it all?”

His is a common, and understandable, question. While advances in the treatment of varicose veins have come lightyears over the past couple decades, recurrence happens. There are a few key distinctions to understand about recurrence, however, that may influence how you approach your varicose vein treatments.

1) The Statistics

Before the more effective, minimally-invasive techniques practiced today, varicose veins used to be removed through a traditional (and painful) vein stripping procedure. The patient would be under general anesthesia in a hospital setting and a surgeon would remove the saphenous vein and as much of the larger visibly bulging branches as they could in a single operation.

Studies showed that the clinical recurrence rates after 5 years after this traditional vein stripping technique were between 35% and 50%

Newer techniques have dramatically reduced this 5 year clinical recurrence rate to 8%, which is a significant improvement. The reduced recurrence rate can be attributed to a number of factors, including the use of diagnostic ultrasound, endothermal ablation, and improved agents for sclerotherapy.

However, recurrence rate even with the newer techniques creeps up to 15% by 10 years. 

This is for two main reasons:

  1. Heredity is the top risk factor for developing varicose veins, hands down. Your genetic predisposition to varicose veins doesn’t go away even after any current varicose veins are treated. If one of your parents has spider veins, varicose veins, or both, you have a 40% likelihood of developing spider or varicose veins, or both. And if both of your parents have spider veins, varicose veins, or both, you have an 80% chance of developing diseased veins. In other words, if you have a family history of varicose veins, staying on top of them will be life-long.

On top of that, the risk of varicose vein disease increases with age, so between genetics and aging you may have veins that are currently functioning normally but that might fail in the next decade. 

  1. Shortcomings of the newer techniques. Many treatments now revolve around not removing veins but by closing them so that the veins gradually resorb, but sometimes the vein can instead gradually reopen. This simply reflects shortcomings in the techniques of vein treatments in 2019. While greatly improved from over a generation ago, the art of treating varicose veins is still not perfect. 

Plus, the perception that varicose veins “come back” can also be misleading. In many cases, the treated part of the vein does not come back, but another section of that same vein will become diseased. It may appear on the surface that the same vein came back, but it’s a different area of disease. 

2) How To Reduce Your Chance Of Recurrence

That said, there are things you can do to better your odds of not having to deal with varicose vein recurrence. First, it helps to know what doesn’t improve your odds of beating recurrence.

The biggest mistake that people make with varicose vein treatments is: 

  • A) Choosing a vein doctor who doesn’t treat the full extent of their venous disease
  • B) Failing to follow through with all recommended treatments

A) Many doctors specialize in one type of treatment, typically Endovenous Laser Treatment (EVLT). While EVLT is wonderfully effective for treating certain varicose veins that may be visible on the surface of the skin, it’s limited in treating the full extent of a patient’s venous disease. Patients will nearly always be dissatisfied with the result either in the near or long term if physicians, especially those who treat veins on a part time basis even if their clinic name suggests they are full time, are only treating varicose veins with a single treatment. 

Most often, a 3-fold approach—EVLT, ambulatory phlebectomy, and ultrasound-guided foam sclerotherapy—is needed to thoroughly treating varicose vein disease that isn’t visible on the surface of the skin. This more thorough approach can successfully eliminate varicose veins at the source, lowering the rate of recurrence.

B) Even though it’s typical that more than one type of treatment is necessary to effectively eradicate the varicose veins, too many patients stop their treatment process after the first procedure. 

This is because of a false sense of reassurance that their varicose veins—and their symptoms—are “gone.” After the first procedure, Many people’s symptoms, like achy, heavy, tired, or restless legs, go away. People are relieved that their legs are feeling more normal, and think they’re home free. But as discussed above, the root source of the varicose vein disease remains.

The best thing you can do to beat the odds of recurrence is to choose a vein specialist who’s committed to treating your whole network of venous disease, and follow through with the entire course of treatment recommendations. 

Remember, varicose veins are a progressive and chronic disease. They will not get better on their own. It you’re suffering from swelling, aching, heavy, tired, or cramping legs, it may be time to consider getting rid of your varicose veins once and for all. Treatment of varicose veins is quicker and easier than it’s ever been, and is typically covered by insurance

East Tennessee Vein Clinic is offering free screenings for varicose veins through July.

Dr. Douglass and the staff at East Tennessee Vein Clinic are solely dedicated to the treatment of varicose veins, and lead the region in experience and expertise of vein treatments. We treat veins differently than other clinics because of our comprehensive attention to treating the root cause and full extent of each patient’s vein disease. Comprehensive vein treatment is all we do, every day, all day, since 2001.

Visit us online at East Tennessee Vein Clinic, or call 866-281-VEIN, or request an appointment online today. We are offering free vein screenings through the month of July, just mention the offer when making an appointment.

The service was great. Will be back - Thanks for your kindness.

- D. J., Gatlinburg, TN

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