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Abstract
Recurrent varicose veins are the veins which persist after previous operation for varices.
Recurrence after treatment has been reported at a rate of 50% in patients undergoing even well planned and executed primary varicose vein surgery.
The concept of recurring varicose veins has always stimulated discussion among phlebologists. Those who think their treatments are perfect and believe there are no recurrences, only new diseases. Others believe that recurrence demonstrate a disease process that can only be temporarily suppressed, no matter how completely treated at the time.
Four main reasons for recurrence are identified:
a) Insufficient understanding of venous anatomy and hemodynamic; b) Inadequate preoperative assessment;
c) Incorrect or insufficient surgery; d) Development of new locations of superficial to deep insufficiency.
Patients with recurrent varicose veins need care and skill with diagnosis, careful history is taken, involving previous operation and especially anything suggestive of deep venous thrombosis.
Clinical examination shares too much in detection of sites of recurrence. Careful inspection and palpation of the recurrent veins and common perforator sites should be done.
Investigations to detect the reflux that develops in recurrent varicose veins in the form of precise mapping and identification of the possible causes are required for appropriate treatment.
Duplex ultrasound and phlebography are considered the two gold standard investigations for assessment of the venous system especially in cases of recurrence.
There are three courses opened for management of recurrent varicose veins a) Reassurance of the patients and advising him to wear light stocking; b) Injection compression technique; c) Preparation of the patient for re-do surgery.
Operations for recurrent varicose veins include a) Groin redissection in patients with incompetent SFJ; b) Popliteal fossa re-exploration in patients with incompetent SPJ;
c) Interruption of incompetent perforator veins through direct or endoscopic subfacial ligation.
Finally, prevention of recurrent varicose veins could be achieved by proper diagnosis preoperatively, proper investigations and proper planning of the treatment as well as follow up programs.