Varicose veins: As a surgeon, this is one of the most common questions I hear after a successful procedure: “Will it come back?” The honest answer is yes, varicose veins can return, but how they return matters. In many people, it’s not the same veins “coming back to life.” It’s either a treated vein reopening or new veins becoming varicose over time.
Let’s break it down in a simple, practical way.
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First, what treatment actually does
Most modern treatments, such as laser ablation (EVLA), radiofrequency ablation (RFA), glue, foam sclerotherapy, or surgery, aim to shut down the faulty vein that’s allowing blood to fall backwards (reflux). Once that main source is treated, pressure drops in the surface veins and symptoms improve.
But vein disease is a tendency, not a one-time event. Treating the “problem vein” helps a lot, but your body can still develop new weak points later.
NICE specifically tells clinicians to counsel patients that new varicose veins may develop after treatment, and that recurrence is more likely in people being treated for recurrent disease compared with first-time cases.
Two ways varicose veins “come back”:
The treated vein reopens (true recurrence)
Sometimes, a vein that was sealed can partially reopen. Doctors call this recanalisation. It’s one of the main technical reasons varicose veins can reappear after endovenous laser treatment.
This is less common with good technique, proper energy delivery, and correct patient selection, but it can happen.
Clues this may be happening:
- The same area bulges again
- Symptoms return in the same “path” as before
- Ultrasound shows reflux in the treated vein
New veins become varicose veins (disease progression)
This is the more common story: the original problem is fixed, but over months or years, other veins become incompetent and start bulging.
This can happen even after a technically perfect procedure because the underlying tendency remains.
What affects recurrence?
How well the original reflux was mapped:
Varicose veins are not just what you see on the skin. The “root cause” is often higher up, like the great saphenous vein, small saphenous vein, perforator veins, or sometimes pelvic sources.
If the ultrasound mapping is incomplete, you may treat visible veins but miss the main reflux point, and so recurrence shows up early.
Takeaway: A proper duplex ultrasound plan before treatment matters as much as the procedure itself.
The type of treatment and older surgery patterns:
Recurrence is well recognised after older surgical treatments. An NHS patient leaflet notes recurrent varicose veins can occur in as many as 1 in 5 (20%) people after previous surgery.
Modern minimally invasive treatments have improved outcomes, but recurrence can still happen, especially as time passes, because vein disease can progress.
Pregnancy and hormones:
Pregnancy is a major trigger. Increased blood volume, hormone-related vein relaxation, and pressure from the growing uterus can worsen reflux and bring out new varicose veins, even after prior treatment.
Hormonal factors (including hormone therapy in some cases) can also influence vein tone.
Genetics (the biggest one people can’t “control”):
If one or both parents had varicose veins, your risk is higher. It doesn’t mean treatment won’t work. It simply means your veins have a stronger tendency to become weak over time.
Weight, long-standing, and low movement days:
Extra weight increases pressure in leg veins. Jobs that involve long hours of standing (or sitting without movement) reduce the “calf pump” effect that normally helps blood return to the heart.
These factors don’t “undo” your treatment overnight, but they can make progression faster.
Untreated side branches or perforator veins:
Sometimes the main trunk vein is treated correctly, but certain branches keep refluxing, or perforator veins (connecting deep to superficial system) remain incompetent. That can keep pressure high and produce new surface varicosities.
This is why many patients need a second-stage procedure, like foam sclerotherapy or phlebotomy for leftover branches.
NICE also advises patients that they may need more than one session of treatment.
Deep vein issues (less common, but important):
If someone has deep venous reflux, a history of DVT, or significant deep vein obstruction, surface treatments can still help symptoms, but recurrence risk can be higher because the underlying venous pressure remains elevated.
This is exactly why evaluation should be personalised.
When should you worry about “recurrence”?
A few veins showing up again is not automatically dangerous. But you should get checked if you notice:
- New or worsening leg swelling
- Heaviness that returns daily
- Skin darkening, itching, and eczema-like patches near the ankle
- Painful, hard veins or inflammation
- Any bleeding from a varicose vein
- A wound/ulcer that’s slow to heal
These signs suggest ongoing venous pressure and need assessment.
How to reduce the chance of recurrence (real-world advice)
- Get a proper duplex ultrasound before treatment (and not just a “visual” plan).
- Treat the source first (main reflux), then handle branches in a staged way if needed.
- Stay active; walking is underrated; it keeps the calf pump working.
- Manage weight if weight is a factor; even modest loss helps venous pressure.
- If you stand long hours, take movement breaks every 30–45 minutes.
- Use compression stockings if your surgeon recommends them, especially during long travel, heavy workdays, or pregnancy.
- If symptoms return, don’t guess; repeating the ultrasound is the quickest way to know what’s happening.
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Varicose vein treatment is highly effective, but it’s not a “one and done” guarantee for life. Think of it like dental care: you fix the problem, but you still need maintenance and monitoring.
The best way to keep results long-term is a correct diagnosis, complete reflux treatment, and lifestyle support that protects your veins for the years ahead.
