I Had My Varicose Veins Treated but They Came Back

By Jill Buterbaugh, RN, MSN, CRNP, FNP-BC

No they didn’t, you simply had other veins go bad.  The most common reason for developing varicose veins is genetics.  Whatever genetic tendency you have for developing varicose veins is still part of you.  Treating bad veins when they are identified is appropriate when they meet medical criteria, but it will not prevent veins from going bad in the future.

The treatment of varicose veins actually destroys the bad veins.  In the past, the most common procedure was a stripping and ligation where they would tie off the end of the vein with suture material and literally pull out the bad vein.  More recently, thermal ablation procedures have replaced the stripping and ligation procedures.  When thermal ablation is done, the vein is sealed shut using heat. The body then turns the vein into a scar which is eventually reabsorbed.  Often the vein is not able to be seen on ultrasounds about a year after this treatment is done.

Treating smaller diseased veins is generally done with sclerotherapy which is a chemical ablation procedure.  Injections of sclerosant into a vein will destroy the lining of the vein triggering an inflammatory response that causes the vein to swell, the walls stick together and the vein is then turned into a scar which is eventually reabsorbed by the body.  In some instances, the anatomy of the vein will not make treatment with heat or chemical possible, then a procedure called microphelbectomy is done.  This is when small puncture type incisions are made and the veins are physically removed.

If the vein treatments were successful, the veins are permanently gone.  The heat ablation procedures are about 95% effective, the chemical procedures are about 85% effective and the microphlebectomy procedures are 100% effective.  So if the procedures are effective, why do more veins appear?  Our bodies have the capability of growing new veins from any vein in the body.  As the body senses that veins are becoming diseased or failing, it will start to grow new veins to replace them.  Varicose veins do not come back, but other veins can become varicose in the same areas as previous veins.

It is not only genetics that is the culprit.  Another factor that influences the development of varicose veins is hormone levels.  Females tend to develop varicose veins more than men due to fluctuations in hormone levels which allows veins to dilate or stretch more to accommodate an increase in blood volume during normal monthly cycles and pregnancy.  Being overweight, having a sedentary lifestyle, hobbies or occupations that require that you stand or sit in one position for long periods of time, and injuries or surgeries that can interrupt blood return to the heart can all contribute to the development of varicose veins.

So how do you prevent more varicose veins from appearing?  You can’t change your genetics but you can change your lifestyle.  Eating healthy to maintain a normal weight, exercising regularly and avoiding sitting or standing in one position for extended periods of time will help.  Wearing medical grade compression socks is the only non-surgical treatment of varicose veins.  It will not make the veins go away, but it forces the blood out of the surface veins into the deep system to be more effectively returned to the heart.  Research has proven that 20 to 30 mmHg is the compression required and generally, knee high is sufficient.


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