TREATMENT OF RECURRENT VARICOSE VEINS

Varicose veins may recur after the treatment and this may be due to various reasons. When treating recurrent varicose veins, it is important to know the type of the previous operations. However, in principle, a detailed color Doppler ultrasound examination will determine what treatment should be performed for recurred varicosities. Possible causes of recurrence and ideal treatment methods are described below.

 

1. Recurrent varices due to incomplete or incorrect treatment: In such patients, varicose veins are actually untreated. What needs to be done is to perform a detailed color Doppler ultrasound to see the final status and to treat the patient as if no treatment has been performed.

 

2. Recurrent varices after open surgical operation: After ligation & stripping, varicose veins recur in about half of the patients. This is due to the fact that the large saphenous vein is surgically removed and the body creates very fine curved veins as a reaction to the surgical operation. These veins, which are called "neovascularization" and do not contain valves, drain the blood in the groin towards the feet under the effect of gravity and cause recurrent varices. However, such varicose veins are easy to handle. Both neovascularization and varices can be easily treated in 1-2 sessions with ultrasound-guided foam sclerotherapy.

 

 

 

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3. Recurrent varices due to reopening of the vessel closed by laser, radiofrequency etc: In such patients, the reopened vessel should be closed either by laser or radiofrequency for the second time or by ultrasound guided foam sclerotherapy, and then, recurrent varices should be treated with miniflebectomy or foam sclerotherapy.

 

4. Recurrent varices due to a new incompetence in other vessels: A detailed color Doppler ultrasound examination will detect new vessels that leak and close them with appropriate methods. Then, the recurrent varices are treated with miniflebectomy or foam.

 

5. Recurrence of spider varices: Unlike other varicose veins, spider varices are mostly due to genetic or hormonal causes. Therefore, they may recur even after being treated very well. However, this recurrence is usually slow and can be easily treated with a repeat microsclerotherapy.

 

In conclusion, contrary to popular belief, the treatment of recurrent varices is not difficult. However, it is necessary to know exactly the type of recurrence and a detailed color Doppler examination should be performed by an experienced physician. In patients with recurrent varicose veins, ultrasound examination may be difficult to interpret because of the change in vascular anatomy and requires considerable experience. The veins that cause recurrence are generally located deeper than classical varicose veins and can only be seen by color Doppler ultrasound. Therefore, the ultrasound knowledge and experience of the physician performing the treatment of recurrent varicose veins is very important to achieve a good result.

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 Video: Why is Doppler ultrasound so important in varicose veins?