Perth's Leading Specialist in the Treatment of Varicose Veins
Dr Luke Matar | MBBS, FRANZCR, FACP
Varicose veins can come back after treatment
Varicose veins can return months or years after treatment. This is sometimes called recurrent varicose veins, or REVAS, which stands for recurrent varices after surgery.
Recurrence does not always mean the previous treatment was incorrect. Varicose vein disease can progress over time, and new abnormal veins can develop after earlier veins have been treated.
However, recurrent varicose veins are often more complex than first-time varicose veins, particularly if you have previously had vein stripping, ultrasound-guided foam sclerotherapy (UGFS), or multiple previous vein procedures.
Why do varicose veins come back?
Recurrent varicose veins can occur for several reasons. In many patients, there is more than one contributing factor.
New veins can become incompetent over time, allowing blood to pool and form new varicose veins.
Sometimes the visible surface veins were treated, but the underlying source of reflux was not fully identified or treated.
After surgical stripping, scar tissue and small new abnormal veins (a process called neovascularisation) can develop, particularly around the groin or upper thigh.
Recurrent veins may be short, twisted, scattered, or connected to multiple small branches rather than running in a simple straight line.
Why recurrent veins can be harder to treat
First-time varicose veins often follow more predictable patterns. Recurrent veins can be different.
After previous treatment, the anatomy may be distorted. The veins may be surrounded by scar tissue, may not follow the expected pathway, or may appear as scattered branches across the thigh, calf, groin or ankle region.
This is especially common after previous stripping or UGFS. The veins are not always straight, and they do not always follow standard anatomy. Irregular branches may be scattered across several areas, making treatment more difficult than treating a straightforward great saphenous or small saphenous vein. Often veins also occur in more than one anatomic region (ie front, back and side of leg rather than just calf) further complicating treatment
For this reason, recurrent varicose veins often need more detailed assessment and a more flexible treatment plan. A single treatment method may not be enough.
Many recurrent cases require a combination of treatments, such as endovenous laser ablation (EVLA), ultrasound-guided foam sclerotherapy (UGFS), ambulatory phlebectomy, or ultrasound-guided phlebectomy.
Assessment starts with detailed ultrasound mapping
The most important step in treating recurrent varicose veins is a careful duplex ultrasound scan.
This scan is used to map which veins have already been treated, whether any treated veins have reopened, whether new reflux has developed, and how the visible varicose veins connect to deeper feeding veins.
This mapping is important because recurrent veins can be misleading. The largest visible vein is not always the main source of the problem. If you have records or ultrasound reports from your previous treatment, bring them to your assessment — knowing exactly what was done before helps in interpreting the current scan.
Our approach to recurrent varicose veins
At The Vein Clinic, recurrent varicose veins are assessed carefully before treatment is planned. The aim is to understand the full pattern of reflux, not just treat the most obvious visible veins.
In recurrent cases, Dr Matar may use a combination of treatment methods, including extended laser techniques for selected non-truncal veins, UGFS, and ultrasound-guided phlebectomy.
This approach can be particularly useful when recurrent veins are not straight, do not follow standard anatomical pathways, or are difficult to remove using standard surface phlebectomy alone.
Extended laser techniques for selected recurrent veins
Standard EVLA is commonly used to treat larger straight refluxing veins, such as the great saphenous vein or small saphenous vein.
In some recurrent cases, the problem veins are not standard truncal veins. They may be abnormal branch veins, recurrent channels, or non-truncal veins that still contribute to significant reflux.
Where suitable, extended laser techniques may allow selected abnormal veins to be treated under ultrasound guidance, even when they sit outside the usual great or small saphenous vein pattern.
This is not appropriate for every vein, but it can be helpful in carefully selected recurrent cases.
Ultrasound-guided phlebectomy and UGFP
Phlebectomy is used to remove larger bulging surface veins through very small skin punctures.
In recurrent disease, the target veins may be hard to see, hard to feel, or difficult to follow because of scarring or unusual anatomy. Ultrasound guidance can help identify and target these veins more accurately.
Ultrasound-guided phlebectomy may be used when recurrent veins are deeper, less obvious on the surface, or running in a pattern that is difficult to assess by appearance alone.
In some cases, ultrasound-guided phlebectomy may be combined with foam sclerotherapy. This is a combined technique developed and refined at our clinic, known as UGFP: ultrasound-guided foam sclerotherapy and phlebectomy — with ultrasound guidance used throughout both stages of the procedure.
This can help address both larger removable veins and smaller residual branches in selected patients, depending on the ultrasound findings.
Will all recurrent veins need treatment?
Not always. Some recurrent veins are mainly cosmetic. Others cause aching, heaviness, swelling, inflammation, skin changes, superficial thrombosis or bleeding.
Treatment is usually considered when recurrent veins are causing symptoms, when there is medically significant reflux, or when there are skin changes or other complications of venous disease.
A consultation and duplex ultrasound scan can help determine whether treatment is recommended, and which treatment options are suitable.
Symptoms to watch for
Recurrent varicose veins can cause the same symptoms as first-time varicose veins, including: aching or heaviness in the legs; throbbing or burning discomfort; swelling around the ankle or lower leg; itching or skin irritation; bulging veins that become tender or inflamed; restless legs or night aching; skin discolouration around the ankle; episodes of superficial venous thrombosis; bleeding from fragile surface veins; and venous ulceration in more advanced cases.
Seek urgent medical care if you develop sudden swelling and pain in one leg, especially in the calf, as this may indicate a deep vein thrombosis (DVT).
Meet Your Vein Specialist
Dr Luke Matar
MBBS, FRANZCR, FACP
Dr. Luke Matar is a dual qualified fellow of the Royal Australian and New Zealand College of Radiologists and Australasian College of Phlebologists. He has over 20 years of experience in diagnostic ultrasound and procedural ultrasound and is one of the most highly trained and experienced varicose vein specialists in the country having performed thousands of treatments with an impeccable success rate.
Further to this, he is the only Australian to have been personally trained by the inventor of laser perforator vein ablation, the world-renowned UK-based EVLA expert Professor Mark Whiteley. His specialised training in laser treatment for varicose veins, dedicated focus to only treating veins along with his personal and family experience with varicose veins gives him a unique perspective and focus not found elsewhere meaning you can be sure you will be getting world class vein care tailored to your needs.
Frequently Asked Questions
Recurrence is a recognised outcome after every treatment method — stripping, laser, glue and sclerotherapy alike — because varicose vein disease is progressive: treating today’s faulty veins does not prevent other veins developing reflux in future years. Recurrence therefore does not automatically mean your earlier treatment was done poorly, although incompletely treated reflux is one recognised cause. An ultrasound scan can usually distinguish new disease from a previously treated vein that has reopened.
Usually, yes. Recurrence after stripping often involves networks of small new veins around the groin or thigh (neovascularisation) and irregular branch patterns, which are poorly suited to repeat surgery but can frequently be treated with ultrasound-guided methods — foam sclerotherapy, ultrasound-guided phlebectomy and, in selected veins, extended laser techniques — without another operation.
Not necessarily. Recanalisation — a treated vein partly or fully reopening over time — is a recognised behaviour of foam sclerotherapy, and new reflux can also develop in previously normal veins. A duplex scan establishes which has happened, and reopened or new veins can generally be retreated, sometimes with a different method better suited to the current anatomy.
It is usually more complex to plan rather than more dangerous to undergo. Scar tissue, distorted anatomy and scattered branches make careful ultrasound mapping and a flexible, often staged, combination of techniques more important than in first-time disease. The procedures themselves remain minimally invasive, walk-in walk-out treatments under local anaesthetic.
No honest clinic can promise veins will never return, because the underlying tendency to develop vein disease remains. What treatment can do is address the current pattern of reflux as thoroughly as possible — which is why the assessment maps all sources, not just the visible veins — and periodic review can pick up any new reflux early, when it is simplest to treat.
No. Recurrent veins can be assessed at any clinic with appropriate ultrasound expertise. It does help to bring whatever records you have of the previous treatment — operation notes, ultrasound reports, or even just the year and type of procedure — as this makes the current scan easier to interpret.
Book an assessment
If your varicose veins have returned after previous treatment, a detailed assessment can help identify why they have come back and what options are available.
At The Vein Clinic, recurrent varicose veins are assessed with duplex ultrasound mapping and an individualised treatment plan.
Contact our clinic to arrange an appointment. Book an assessment or use our online leg assessment tool as a first step.
This page provides general information only and is not a substitute for a medical consultation. A duplex ultrasound assessment is required before any treatment recommendation can be made.
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