Let me start by sharing a story. An American mother of three came to see me, and after having her first baby 10 years ago, she discovered that she had mild varicose veins and underwent sclerotherapy in the United States to eliminate the localized veins in order to fit back into her bikini. Then she came to China and had two more babies and subsequently developed new varicose veins, which were worse than the original ones.
I understood the situation and gave her an ultrasound. Since the trunk had not been treated the first time, the lesions in the trunk had worsened and caused a “recurrence” of the varicose veins.
When I asked her what she wanted to fix this time, she said, “My American doctor told me that sclerotherapy was a temporary treatment and that it could come back after the baby, and I was absolutely right. I’m relapsing this time, and I want to be completely treated!”
Compared to her relaxed calmness, our other patient’s experience was much more painful.
He, too, had undergone a traditional surgery locally 10 years ago because of his varicose veins. Back then, the surgery was not comparable to today’s minimally invasive same-day surgery, with large incisions, lots of bleeding, a month-long hospital stay, slow recovery, and disruption of work and life.
Unfortunately, despite the pain he experienced, he had a recurrence 1 year after the surgery. This time he kept delaying to go to the doctor and would advise the varicose patients around him: “Don’t have surgery, it will come back even if you have surgery”. It was only when he got worse that his son tried to persuade him to come to the doctor. On the one hand, he wanted to undergo a second surgery, but on the other hand, he was so worried about a recurrence that he needed to check with his doctor again and again.
I can understand this type of patient very well. The poor experience of the first treatment and the inadequate communication with the doctor led to the patient’s reluctance to go through the painful process again. It greatly undermines his confidence in the surgery.
Can surgical recurrence of varicose veins be avoided?
Worldwide statistics show that the surgical recurrence rate of varicose veins in the lower extremities is 10-20%, however, in our team, the surgical recurrence rate is less than 1%.
Years of experience tell us that surgical recurrence can be avoided in most cases!
The following 7 issues are some of the most important factors that lead to recurrence. The following 7 issues are some of the most important factors leading to recurrence. These are summarized from numerous cases I have encountered in my clinical work and after reviewing relevant books and literature.
If you are able to, ask your surgeon these questions, as it will be beneficial to fully understand the condition and the procedure.
Where are the sources of my varicose veins?
In the past, varicose veins in the lower extremities were collectively referred to as “saphenous varicose veins”, which is a real cause for misdiagnosis.
According to statistics, about 70% of lower extremity varicose veins occur in the saphenous vein, another 20% in the small saphenous vein, and about 10% in other types of varicose veins, such as the communicating branch type, the paraphenous vein, and other branch vein types.
Regardless of what these difficult terms are, you need to understand that the different sources of varicose veins are often difficult to distinguish by appearance alone and require personal ultrasound examination and localization by the surgeon. The choice of surgical incision location also varies. Otherwise, the veins that are really problematic can easily be missed, leading to recurrence.
The diagram above shows the anatomical difference between the Great Saphenous Vein, which runs along the medial aspect of the thigh, and the Lesser Saphenous Vein, which runs along the posterior aspect of the calf.
Do I have a malformation or variation in my vein?
Even if the right source is found, it is important that the surgeon scans the patient for the entire course.
Anatomical variations of veins are very common and widespread in the population. Studies have found that one-third of the population has a double saphenous vein system – two parallel saphenous veins; anatomic variations at the point where the small saphenous vein joins the national vein are more common and easily missed.
If a conventional incision is made without preoperative localization and based on previous experience alone, the vein may be silly to find intraoperatively, requiring an enlarged incision or only declaring the procedure a failure.
(The patient is undergoing preoperative marking and ultrasound localization to track the diseased vein and to rule out anatomical abnormalities and location variations)
Is my deep vein patent?
Surgery is often ineffective in cases of increased venous pressure and varicose veins in cases of poorly patent deep veins such as deep vein thrombosis disease.
The doctor identifies this by taking a careful history and performing the appropriate physical examination.
Which surgical procedure is best for me?
There are many surgical options for varicose veins, including the traditional venous stripping procedure, CHIVA procedure, and SEPS procedure. Venefit endovenous radiofrequency treatment, endovenous laser treatment (EVLT), and sclerotherapy (Sclerotherapy), which have been well recognized in Japan and abroad in the last 10 years. With the mature operation of same-day surgery platform, varicose vein surgery has been brought in line with foreign countries with no hospitalization and same-day walk.
Experienced surgeons will often discuss and decide on the most appropriate option in conjunction with the patient’s condition, sometimes requiring a combination of techniques for the same patient.
Will sclerotherapy solve my varicose veins?
Sclerotherapy is generally used in combination with other techniques to manage localized varicose veins and is rarely used as a stand-alone technique to treat varicose veins.
If the trunk is already diseased but sclerotherapy is only used locally – as mentioned at the beginning of the article for the American mom – it can come back years later.
If I have surgery now, will varicose veins occur in the other leg later?
With a clear diagnosis and precise localization, the surgery will successfully deal with both the main stem and the original lesion.
If the other side of the venous system turns out to be normal, the chances of developing varicose veins are the same as normal and there is no need to worry too much. Some daily health care measures can prevent the occurrence of varicose veins.
As the body ages, subtle reticular veins or dilated capillaries may develop in other areas. This is not strictly a recurrence and does not usually progress, but can be treated with sclerotherapy if appearance is important (especially for women who love to look good and wear dresses).
(Dilated reticular veins and capillaries occur due to changes in hormone levels and aging of the body.)
I am a patient with surgical relapse, can you help me not to relapse this time?
A recurrence of surgery is not simply a matter of having another surgery. The doctor should look more carefully for the causes of recurrence (as listed in points 1 to 5 above) and make targeted treatment. Of course, the second surgery will be more difficult and more demanding for the surgeon.
(The picture shows the before and after surgery)
As a vein surgeon, it is important to fully understand the needs and concerns of the varicose vein patient before surgery, to carefully examine and locate, to fully communicate, and to discuss a customized and individualized treatment plan.