Year 2015 Vol. 23 No 4




SBEE DPE "Irkutsk State Medical Academy of Post-Graduate Education"
The Russian Federation

The article presents an overview of domestic and foreign literature on the etiology, diagnosis and treatment of recurrent varicose veins. Two current classification schemes to assess the recurrence of varicose veins of the lower limbs, depending on the primary surgery: REVAS and PREVAIT have been proposed. Moreover the incidence of recurrence of varicose veins after different methods of eliminating of primary disease has been analyzed. The literature review summarizes the views of a number of foreign authors concerning the definition of the concept of "recurrence of varicose veins of the lower extremities". The conventional concepts and current hypotheses concerning the causes of this complication are presented. The significance of ultrasound duplex angioscanning leg veins as the best diagnostic method to identify accurately the main pathological and hemodynamic causes of disease recurrence has been highlighted. The feature of both classical and current correction methods of recurrent lower limb varicose veins is given in the review. The using of the combination of various non-surgical treatment techniques depending on the definite clinical situation allows increasing the modern high quality medical aid provided to such severe patients is demonstrated.

Keywords: lower limb varicose veins, recurrence, operation, foam sclerotherapy, laser obliteration, radiofrequency obliteration, miniphlebectomy
p. 447-451 of the original issue
  1. Winterborn RJ, Foy C, Earnshaw JJ.Causes of varicose vein recurrence: late results of a randomized controlled trial of stripping the long saphenous vein. J Vasc Surg. 2004 Oct;40(4):634-9.
  2. Robertson L, Evans C, Fowkes FG. Epidemiology of chronic venous disease. 2008;23(3):103-11. doi: 10.1258/phleb.2007.007061.
  3. Beebe-Dimmer JL, Pfeifer JR, Engle JS, Schottenfeld D. The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol. 2005 Mar;15(3):175-84.
  4. Kostas T, Ioannou CV, Touloupakis E, Daskalaki E, Giannoukas AD, Tsetis D, Katsamouris AN.Recurrent varicose veins after surgery: a new appraisal of a common and complex problem in vascular surgery. Eur J Vasc Endovasc Surg. 2004 Mar;27(3):275-82.
  5. Chapman-Smith P, Browne A. Prospective five-year study of ultrasound-guided foam sclerotherapy in the treatment of great saphenous vein reflux. Phlebology. 2009 Aug;24(4):183-88. doi: 10.1258/phleb.2009.008080.
  6. Perrin MR, Guex JJ, Ruckley CV, dePalma RG, Royle JP, Eklof B, Nicolini P, Jantet G.Recurrent varices after surgery (REVAS), a consensus document. REVAS group. Cardiovasc Surg. 2000 Jun;8(4):233-45.
  7. Eklof B, Perrin M, Delis KT, Rutherford RB, Gloviczki P.Updated terminology of chronic venous disorders: the VEIN-TERM transatlantic interdisciplinary consensus document. J Vasc Surg. 2009 Feb;49(2):498-501. doi: 10.1016/j.jvs.2008.09.014.
  8. Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, Lohr JM, McLafferty RB, Meissner MH, Murad MH, Padberg FT, Pappas PJ, Passman MA, Raffetto JD, Vasquez MA, Wakefield TW. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011 May;53(5 Suppl):2S-48S. doi: 10.1016/j.jvs.2011.01.079.
  9. Perrin MR, Labropoulos N, Leon LR Jr.Presentation of the patient with recurrent varices after surgery (REVAS). J Vasc Surg. 2006 Feb;43(2):327-34.
  10. Rasmussen L, Lawaetz M, Bjoern L, Blemings A, Eklof B.Randomized clinical trial comparing endovenous laser ablation and stripping of the great saphenous vein with clinical and duplex outcome after 5 years. J Vasc Surg. 2013 Aug;58(2):421-26. doi: 10.1016/j.jvs.2012.12.048.
  11. Jones L, Braithwaite BD, Selwyn D, Cooke S, Earnshaw JJ. Neovascularisation is the principal cause of varicose vein recurrence: results of a randomised trial of stripping the long saphenous vein. Eur J Vasc Endovasc Surg. 1996 Nov;12(4):442-45.
  12. Pittaluga P, Chastanet S, Rea B, Barbe R. Midterm results of the surgical treatment of varices by phlebectomy with conservation of a refluxing saphenous vein. J Vasc Surg. 2009 Jul;50(1):107-18. doi: 10.1016/j.jvs.2008.12.067.
  13. Blomgren L, Johansson G, Dahlberg-AKerman A, Norén A, Brundin C, Nordström E, Bergqvist D. Recurrent varicose veins: incidence, risk factors and groin anatomy. Eur J Vasc Endovasc Surg. 2004 Mar;27(3):269-74.
  14. Theivacumar NS, Dellagrammaticas D, Darwood RJ, Mavor AI, Gough MJ Fate of the great saphenous vein following endovenous laser ablation: does re-canalisation mean recurrence? Eur J Vasc Endovasc Surg. 2008 Aug;36(2):211-15. doi: 10.1016/j.ejvs.2008.03.014.
  15. Theivacumar NS, Dellagrammaticas D, Beale RJ, Mavor AI, Gough MJ. Factors influencing the effectiveness of endovenous laser ablation (EVLA) in the treatment of great saphenous vein reflux. Eur J Vasc Endovasc Surg. 2008 Jan;35(1):119-23
  16. Brittenden J, Cotton SC, Elders A, Tassie E, Scotland G, Ramsay CR, Norrie J, Burr J, Francis J, Wileman S, Campbell B, Bachoo P, Chetter I, Gough M, Earnshaw J, Lees T, Scott J, Baker SA, MacLennan G, Prior M, Bolsover D, Campbell MK. Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins: results from the Comparison of LAser, Surgery and foam Sclerotherapy (CLASS) randomised controlled trial. Health Technol Assess. 2015 Apr;19(27):1-342. doi: 10.3310/hta19270.
  17. Rabe E, Pannier F, Ko A, Berboth G, Hoffmann B. Incidence of Varicose Veins, Chronic Venous Insufficiency, and Progression of the Disease in the Bonn Vein Study II. S. HertelDOI: March 2010;51(3):791.
  18. De Maeseneer MG. The role of postoperative neovascularisation in recurrence of varicose veins: from historical background to today's evidence. Acta Chir Belg. 2004 Jun;104(3):283-89.
  19. van Rij AM, Jones GT, Hill GB, Jiang P.Neovascularization and recurrent varicose veins: more histologic and ultrasound evidence. J Vasc Surg. 2004 Aug;40(2):296-302.
  20. Theivacumar NS, Darwood R, Gough MJ. Neovascularisation and recurrence 2 years after varicose vein treatment for sapheno-femoral and great saphenous vein reflux: a comparison of surgery and endovenous laser ablation. Eur J Vasc Endovasc Surg. 2009 Aug;38(2):203-7. doi: 10.1016/j.ejvs.2009.03.031
  21. Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, Sessa C, Schuller-Petrovic S. Prospective randomised study of endovenous radiofrequency obliteration (closure) versus ligation and vein stripping (EVOLVeS): two-year follow-up. Eur J Vasc Endovasc Surg. 2005 Jan;29(1):67-73.
  22. De Maeseneer MG, Vandenbroeck CP, Van Schil PE. Silicone patch saphenoplasty to prevent repeat recurrence after surgery to treat recurrent saphenofemoral incompetence: long-term follow-up study. J Vasc Surg. 2004 Jul;40(1):98-105.
  23. Maleti O, Perrin M. Reconstructive surgery for deep vein reflux in the lower limbs: techniques, results and indications. Eur J Vasc Endovasc Surg. 2011 Jun;41(6):837-48. doi: 10.1016/j.ejvs.2011.02.013.
  24. Castenmiller PH, de Leur K, de Jong TE, van der Laan L. Clinical results after coil embolization of the ovarian vein in patients with primary and recurrent lower-limb varices with respect to vulval varices. Phlebology. 2013 Aug;28(5):234-38. doi: 10.1258/phleb.2012.011117.
  25. Darvall KA, Bate GR, Adam DJ, Silverman SH, Bradbury AW. Duplex ultrasound outcomes following ultrasound-guided foam sclerotherapy of symptomatic recurrent great saphenous varicose veins. Eur J Vasc Endovasc Surg. 2011 Jul;42(1):107-14. doi: 10.1016/j.ejvs.2011.03.010.
  26. Hinchliffe RJ, Ubhi J, Beech A, Ellison J, Braithwaite BD. A prospective randomised controlled trial of VNUS closure versus surgery for the treatment of recurrent long saphenous varicose veins. Eur J Vasc Endovasc Surg. 2006 Feb;31(2):212-18.
Address for correspondence:
664013, Russian Federation,
g. Irkutsk, m-n Yubileynyiy d. 100, GBOU DPO "Irkutskaya gosudarstvennaya meditsinskaya akademiya poslediplomnogo obrazovaniya", kafedra khirurgii,
tel. office: 8 3952 638-176,
Smirnov Aleksey Anatolevich
Information about the authors:
Smirnov A.A. PhD, an assistant of the surgery chair of SBEE DPE "Irkutsk State Medical Academy of Post-graduate Education".
Kulikov L.K. MD, professor of the surgery chair of SBEE DPE "Irkutsk State Medical Academy of Post-graduate Education".
Privalov U.A. MD, an associate professor of the surgery chair of SBEE DPE "Irkutsk State Medical Academy of Post-graduate Education".
Sobotovich V.F. PhD, an associate professor of the surgery chair of SBEE DPE "Irkutsk State Medical Academy of Post-graduate Education".
Contacts | ©Vitebsk State Medical University, 2007-2023