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In varicose veins, most recurrences are due to inadequate treatment 


Although it is often said otherwise, yes, varicose veins may recur. This is because varicose veins are mainly a genetic predisposition disease. Therefore, a perfect treatment dose reduce the likelihood of recurrence, but it does not eliminate the possibility, because although we can treat the existing disease perfectly, we cannot alter the genes that cause this disease.


However, the most important reason for the recurrence of varicose veins is actually "inadequate" treatments done for  a temporary aesthetic improvement. This is most commonly seen in cases where varicose veins are removed by sclerotherapy or phlebectomy without investigating and treating the underlying venous insufficiency. After these treatments, the varices decrease temporarily, but they recur rapidly after some months because the underlying insufficiency is not treated. In these patients, varicose veins are thought to recur, but in fact, they have not been treated adequately.


We often see inadequate treatment also as a result of incomplete or incorrect color Doppler examinations. In patients with multiple vessel venous insufficiency, for example, in cases of combined great saphenous and pelvic vein insufficiency, the latter is often overlooked, and even if the great saphenous vein is completely ablated with laser or RF, the veins descending from the groin regenerate into the leg and cause varicose veins again. A similar situation is seen in cases where the saphenous vein is ablated only partially in the thigh. In this case, there may be a connection between the veins from the groin and the vein that is open below and varicose veins recur.


So far, I have explained how varicose veins can be renewed as a result of incomplete or incorrect treatments. However, varicose veins may sometimes recur even after an excellent treatment. This may happen in several ways:


1. Re-opening of the incompetent vein which is closed by means of laser, radiofrequency etc: This possibility depends on the diameter of the vessel and the type of treatment applied. In general, after laser treatment, reopening of the ablated vessel may be seen on color Doppler ultrasound in approximately 5% of patients. The reopened vessel can be ablated again with a second laser or foam sclerotherapy treatment. Re-opening of the treated vessel may also be seen in radiofrequency, MOCA and Glue treatments in the range of 5-15%. In general, the larger the diameter of the treated vessel, the greater the likelihood of reopening.


2. A new insufficiency occurs in vessels other than the treated vessel: If a person has a strong genetic predisposition, or if he / she has a risky occupation (porter, waitress, dentist, etc.), venous insufficiency may develop in other vessels even if the incompetent vein has been successfully treated, In this case, the new incompetent vein can be treated with laser, RF etc again and the problem will be solved.


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


In conclusion, the most important reason for recurrence of varicose veins is inadequate treatment. However, there is a possibility that varicose veins may recur even after a perfect treatment.

Spider and reticular varices are less affected by environmental factors. Such veins are much more dependent on genetic or inherent factors and are not affected by factors such as standing, wearing high-heel shoes, and living in a warm climate. Therefore, people with such varices do not need to make any changes in their lifestyle to prevent varicose veins.

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

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