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Operations for Recurrent Varicose Veins What are recurrent varicose veins? Recurrent varicose veins occur when you have previously had treatment for varicose veins. Treatment can include injections like sclerotherapy, avulsions, cuts in the groin or cuts behind the knee. What causes recurrent varicose veins? There are several reasons for veins coming back after treatment: 1. Normal veins become varicose. If you have had varicose veins in the past then you are more likely to develop more varicose veins. For example, you may have had an operation for varicose veins when there has been a cut in the groin. This may have been done if you had varicose veins on the inside of your calf or thigh (long saphenous varicose veins). If your recurrent varicose veins are behind your calf on the same leg then you may have developed new varicose veins in the area of the short saphenous vein. These short saphenous varicosities were probably normal veins when you had your first operation. Over time and because you have a tendency to have varicose veins, the normal veins have become varicose. 2. Neovascularisation When a cut has been made in the skin, the wound heals because living tissue has the ability to regenerate. When this happens, new blood vessels grow to provide a means for blood to get to the new skin. The same process is thought to happen in the area where varicose veins have been treated by surgery. The new veins (neo = new, vascularisation = vessel formation), appear to grow from the site of the vein ligation, most commonly the sapheno-femoral junction. The new veins are like weeds growing in the garden. If they connect up to an original main vein, then blood flows through them, runs into the area of varicose veins in the leg. This will cause recurrence of your varicose veins. If the long saphenous vein in your leg was not removed at the original operation then the new veins can connect with it and cause recurrence. People who have this type of recurrence may be suitable for VNUS treatment to remove their veins. 3. Inadequate initial treatment In the past and rarely now, the surgeon who performed your original varicose vein surgery may not have treated all of the areas of varicose veins. There can be several reasons for this. 4. Pudendal and pelvic varicose veins Some recurrent varicose veins are caused by connections to veins inside the pelvis. In some people the problem can arise in the veins that run from the testicles or ovaries (gonadal veins). If the blood runs in the wrong direction in these veins (gonadal reflux) then there can be a long column of blood pushing blood out of the pelvis and down the leg. How are recurrent varicose veins treated? In much the same way as primary varicose veins (those that have not been operated upon). It is important to know exactly where and how the recurrent veins are formed. To do this, Mr Braithwaite together with most vascular surgeons, arranges an ultrasound scan called a Duplex. This scan, performed by a trained technician, can give Mr Braithwaite an accurate 'map' of the veins in the leg. With this information, Mr Braithwaite can 'tailor' the operation to your requirements. What does recurrent varicose vein surgery involve? This depends on the type of recurrence you have. If you need another cut in the groin, you may be suitable for VNUS. If you need another cut in the groin, the scarring from the previous can make the surgery more difficult. This means the operation can take longer and there are increased risks. You may be more likely to develop a wound infection, swelling in the groin and rarely permanent swelling of the leg. This can happen if the lymphatics have been damaged by the first operation and the redo or recurrent surgery causes further damage. At worst you could develop lymphoedema. New techniques like VNUS, EVLT and Varicofoam can avoid these complication. If you need another cut behind the knee, then you have recurrent short saphenous disease. You may need a much larger cut than before so that the surgeon can carefully identify the blood vessels and nerves behind you knee. With this operation, you may be at increased risks of wound infection and damage to nerves.It might be worth considering varicofoam therapy if you have recurrent short saphenous vein disease. Mr Braithwaite is performing a study on the techniques. |