Failed surgical stripping resulting in recurrent Varicose Veins.

Failed surgical stripping resulting in recurrent Varicose Veins.

Recurrent Varicose Veins After Surgery (REVAS)

In 1929, H.O. McPheeters, M.D., F.A.C.S., The Director of the Varicose Vein and Ulcer Clinic, Minneapolis General Hospital, writes on page 3 in his introduction to” Varicose Veins”:

“The author has often been impressed with the amount of disability that accompanies the extreme and complicated cases of varicose veins and by the fact that such patients may become invalids for life, when under proper care and treatment they might again be made useful members of society.  He does not believe that the medical profession as a whole realizes the importance of this condition and how miserable may be the patients so afflicted. The time honored and accepted excision of the offending vein, in the hope of cure, has been unsuccessful in such a large percentage of cases that we must seek new and more effective methods of treatment. The author has often seen varices redevelop and recur even though cared for by the most able surgeons.

Recurrent Varicose Veins after Surgery (REVAS) is a frequent and sometimes major complication following traditional high ligation and stripping.   It has long been known that there is a high rate of secondary recurrent varicose veins after surgery with reported incidences of anywhere between 50-65% within 5 years. [1]

These unacceptably high recurrence rates following surgery have led to research with the aid of Duplex Ultrasound, resulting in a reappraisal of the cause of varicose veins following surgery.  It is now thought they are more often due to “neovascularization” rather than a problem of surgical “failure”.[2]

Neovascularization is the development of new venous pathways and studies have shown that this is perhaps the principle cause of recurrence following surgery.[3] [4]

This new understanding is now leading to the abandonment of surgery and a movement towards new techniques such as endovenous thermal ablation, endovenous adhesive ablation and ultrasound guided sclerotherapy. 

International guidelines from the UK, USA and Europe now recommend endothermal ablation and ultrasound guided sclerotherapy as first line treatments for varicose veins. [5] [6] [7]

If you have had your varicose veins stripped and they have recurred please come and talk to Dr Kemp.  He will understand as it happened to him!

  1. Royle, J.P., Recurrent varicose veins. World Journal of Surgery 1986. 10(6): p. 944-953 
  2. van Rij, A.M., et al., Recurrence after varicose vein surgery: a prospective long-term clinical study with duplex ultrasound scanning and air plethysmography. Vascular Surgery, 2003. 3(8): p. 935-943.
  3. Jones, L., et al., Neovascularisation is the principal cause of varicose vein recurrence: Results of a randomised trial of stripping the long saphenous vein. European Journal of Vascular and Endovascular Surgery, 1996. 12(4): p. 442-445.
  4. De Maeseneer, M., Neovascularization: An adverse response to proper groin dissection, in The Vein Book, J.J. Bergan, Editor. 2006, Elsevier: London. p. 239-246.
  5. Perrin, M. and J.L. Gillet, Management of recurrent varices at the popliteal fossa after surgical treatment. Phlebology, 2008. 32(2): p. 64 - 68.
  6. Pichot, O., et al., Duplex Ultrasound Findings two years after Great Saphenous Vein Radiofrequency Obliteration. Journal of Vascular Surgery, 2004. 39: p. 189-195.
  7. Welchman, S.A., A. Elstone, and S. Ashley, Treatment of recurrent varicose veins using ultrasound-guided foam sclerotherapy. British Journal of Surgery, 2010. 97(April Supplement 2): p. 2-202.