I regularly hear the comment: “I had my veins treated but they came back”. This is not an uncommon situation.
There are three main reasons as to why varicose veins come back again after treatment. These include:
Let’s look at these three reasons in more detail.
The incorrect veins were treated or not all veins that required therapy were treated.
It is imperative that when evaluating somebody with varicose veins that a duplex ultrasound is performed. We need to know which veins are involved before the correct treatment can be performed.
The bulging veins that are seen at the skin surface are typically just the “tip of the iceberg”.
This scan should be performed by a person experienced in performing venous ultrasound otherwise there is the potential that veins that are a significant part of the problem may not be recognised and therefore not treated.
These scans take time. If your scan took just a few minutes then it would not be surprising that some important contributing veins would be missed and not treated leading to suboptimal outcomes. Wrong veins could be treated and those that should be treated – missed!
Scans should take 15-20 minutes, or even longer, per leg, especially if there is significant disease.
The right veins were treated but with incorrect techniques
The type of treatment performed depends on the size and distribution of veins. There are many techniques available to treat veins.
This inevitably leads to 2 separate issues:
The first is variation in cost. With so many techniques and devices available, it is not surprising that there is a wide discrepancy in what an individual may be charged by different practitioners or even the same practitioner.
The second is the correct choice of technique employed in a particular patient (every patient has to be assessed for their individual needs).
This is where the expertise and experience counts; choosing the correct method of treatment in a particular patient.
Surgical approach, endovenous laser ablation, ultrasound guided foam sclerotherapy, ambulatory phlebectomy or micro-sclerotherapy could be performed, alone or in combination; this will depend on many factors, including vein distribution and size, patients age, background medical disease and outcome from previous therapies.
It is therefore very important that one does research when choosing a person to treat your veins. Choose someone who has the experience and is well recognised in vein therapy management, so one can achieve the best possible outcome. This may not necessarily be the cheapest option.
New varicose veins form over time. This is the most common reason.
The natural history of vein disease is that new valveless veins develop over time. Family history/genetics is the most common reason that this occurs. Neo-vascularisation – This term means that tiny veins grow over time. The body is programmed to grow these new veins. The cause for this is not known. In addition, some patients have more than one site from where the veins originate, this not being evident at time of treatment.
Of course poor or suboptimal / incomplete treatment and removal of existing varicose veins that then continue to grow/enlarge can occur.
People create significant varicose veins after treatment is variable, but usually in the order of 4-5% per year.
What can I do as a patient to help?
There is a limitation to what an individual person can do to limit recurrence. The best one can do is as follows:
If you have venous disease but are unsure whether these are of any clinical significance or if you have spider vein disease that worry you, please give us a call and organise an appointment.
We can discuss your particular venous issue, discuss options and create an individualised treatment plan if required. The venous disease that you have may well require reassurance only with no treatment required.
To make an appointment today to have your venous disease assessed by Dr Berman, please phone 95615155