If yes, what are the causative factors?
Varicose veins are twisted twins. Any enlarged, superficial vein can become varicose, but the legs are the most common area to get affected with it. The reason behind is the walking and standing upright for a long time that increases the pressure in our lower body’s veins.
For some people, varicose veins, as well as spider veins (a common and mild variation of varicose veins), are just a cosmetic concern whereas for many people, it can cause discomfort highly and aching pain, might lead to more critical issues.
It’s treatment sometimes involves self-care process and approaches by doctors to remove or close the veins.
There is a high possibility of recurrence of varicose veins even after a complete surgical treatment. This recurrence is a big challenge to chronic disease management. In spite of the top technology and minimally invasive therapy, the surgery success rate of varicose veins is pretty low, and this issue has been reported in around 80% of people.
Let’s have a look at the potential causes and prevention of varicose veins recur after treatment.
Incomplete treatment
Treatment of varicose veins often involves cutting off the flow of blood to the damaged veins by redirecting it to nearby veins. Once the malfunctioned vein stopped receiving blood, it vanishes. Alternatively, sometimes, it is eradicated.
In some cases, the venous reflux problem can’t be solved by a single treatment. Hence, the chances of recurrence of varicose veins are higher than expected. The best way to prevent this recurrence is by using duplex examination. These days, duplex ultrasound is very common among doctors. In the early days, there was no proper procedure followed to examine all the potential sources, hence accessory veins, pelvic escape points were often overlooked.
The best treatment for varicose veins is to prevent it from recurrence through complete duplex examination. It would provide a protocol that includes thorough documentation of sources of reflux to prevent it from being overlooked again.
Inept Treatment
In some instances, documents required after the treatment get missed. It’s crucial to perform a thorough duplex examination in order to prevent the recurrence of varicose veins after surgery. There must include a protocol that requires keeping significant reflux sources such as the accessory, pelvic escape points, and perforators at one place.
These sources can be treated in several ways. Accessory veins can be treated with any standard ablative procedure, including chemical, mechanochemical, or thermal.
Incompetent perforator veins can also be treated with these techniques along with thermal ablation, subfascial endoscopic perforator surgery, and ultrasound-guided ligation.
Recanalized Veins
After having thermal, mechanochemical, or chemical ablation, it becomes challenging to treat recanalized saphenous veins. Before taking a step to treat it, it’s necessary to check its clinical significance. If a small lumen diameter is shown in the duplex ultrasound, then there is no need for the treatment. Even if the procedure is needed, it would be challenging to execute it due to the scars present in the lumen by previously treated veins. This scarring in the lumen prevents the catheter from passing through the veins, resulting in the sclerotherapy has no impact on the scarred veins. If a vein accepts catheter, then a standard thermal method can treat it. Otherwise, chemical ablation can be tried next.
Neovascularization
It is another well-documented method after stripping and thermal ablation, though it isn’t common. Neovascularization is a challenging treatment as the vessels are thin-walled and grow in scar tissue from the previous procedure. This may result in some complications, including bleeding and lymphatic injury. Here, thermal treatment is not an option as it would harm catheters. Hence, chemical ablation is the only treatment for this.
Obstructive disease
Recurrence of varicose veins after surgery is frequent in people who have a history of post-thrombotic syndrome or DVT. A deep venous obstruction can be a possible cause of this recurrence, come with severe and advanced symptoms. Hence, it’s necessary for patients suffering from advanced disease or recurred varicose veins to consider venography and intravascular ultrasound.
Conclusion
Undoubtedly, recurrence of varicose veins after treatment is unavoidable or sometimes inexorable. Like any disease, preventing it in the first place can be the most feasible and practical way to reduce the chances of reoccurrence. Doctors can prevent this incidence with various methods as mentioned above, like thorough duplex evaluation as well as treating all the refluxing points escape from one venous system to another.
However, even with proper diagnosis and thorough treatment, recurrence of varicose veins still can’t be stopped, but the surgery success rate can be increased. Treating patients suffering from this disease is challenging and might require proper follow up with various methods like duplex ultrasound evaluation and other modalities.
Dr. Abhilash Sandhyala is one of the best vascular surgeons in Hyderabad. He is a well-known specialist for varicose veins. He has successfully treated varicose veins for more than 5,000 patients. He has been performing the EVLT procedure for the past 4 years with great results.
You can visit Flow Vascular clinic at H.No: 2-22-298/2/A, Sree Krishna Diagnostic Center Building, 2nd Floor, Beside Kalamandir, KPHB Main Road, Kukatpally, Hyderabad. You can also book an appointment on https://drabhilash.com/book-an-appointment/ or call on (+91) 99896 49498, 99590 33037.
Visit https://drabhilash.com/ to know more about the treatment options for varicose veins.