From the Guidelines
The recurrence rate of varicose veins after vein stripping is approximately 20% to 28% within five years of the procedure. This estimate is based on the most recent and highest quality evidence available, including a 2014 Cochrane review cited in a 2019 study published in the American Family Physician journal 1. The relatively high recurrence rate can be attributed to the fact that vein stripping primarily addresses existing varicose veins without preventing the development of new ones. Several key factors contribute to the recurrence of varicose veins, including:
- Genetic predisposition
- Lifestyle factors such as prolonged standing, being overweight, or pregnancy
- The natural progression of venous disease
Recurrence typically occurs through neovascularization, the development of incompetent perforator veins, or the progression of disease in untreated veins. To minimize the risk of recurrence, patients are advised to:
- Wear compression stockings (20-30 mmHg) regularly after surgery
- Maintain a healthy weight
- Avoid prolonged standing or sitting
- Exercise regularly to improve circulation
- Elevate their legs when resting
Regular follow-up with a vascular specialist is crucial for the early detection and management of recurrent varicose veins, as it allows for timely intervention and potentially improves outcomes in terms of morbidity, mortality, and quality of life 1.
From the Research
Recurrence Rate of Varicose Veins after Vein Stripping
The recurrence rate of varicose veins after vein stripping is a significant concern, with various studies reporting different rates. Some key findings include:
- A study published in 2011 found that the recurrence rate of varicose veins after stripping was high, ranging from 20-80% 2.
- Another study from 2012 reported a recurrence rate of 60% after 5 years of follow-up observation 3.
- A retrospective evaluation published in 2010 compared traditional surgical treatment for varicose recurrence with a less aggressive approach, and found that the less aggressive approach led to a reduction in postoperative complications and good medium-term clinical and hemodynamic results 4.
- An analysis of a series of patients with varicose vein recurrence published in 2012 identified several factors that may contribute to recurrence, including failure to ligate perforating veins and initial failure to perform the appropriate surgical intervention 5.
Factors Contributing to Recurrence
Several factors can contribute to the recurrence of varicose veins after vein stripping, including:
- Neovascularization and deep venous thrombosis before and after surgery 3.
- Failure to ligate perforating veins 5.
- Initial failure to perform the appropriate surgical intervention 5.
- Residual saphenous vein 5.
- Blocked iliac veins due to post-thrombotic syndrome 5.
Comparison with Other Treatments
Comparing vein stripping with other treatments, such as endovenous laser therapy, can provide insight into the effectiveness of each approach. For example:
- A study published in 2021 found that endovenous laser therapy had a very low rate of recurrence of varicosity, with no recanalization observed in 38 patients after 6 months of follow-up 6.
- In contrast, vein stripping has been associated with higher recurrence rates, as reported in several studies 2, 4, 3, 5.