Varicose Veins
Will my varicose veins come back after treatment?
Fourteen-year data say it depends enormously on which procedure — twelvefold. Then the same data say quality of life ended up identical, which changes what the recurrence rate is telling you.
Answer
Often, and how often depends on the procedure. In a randomised trial followed for fourteen years, recurrent above-knee reflux occurred in 2.6 percent after high ligation and stripping, 6.1 percent after endovenous laser ablation and 30.8 percent after ultrasound-guided foam sclerotherapy, with re-intervention on the vein required in 13.2, 8.2 and 56.4 percent respectively — yet Aberdeen Varicose Vein Questionnaire scores at fourteen years were comparable across all three groups (overall P = .21).
Key takeaways
- 233 patients with symptomatic great saphenous vein reflux were randomised to stripping, laser ablation or foam sclerotherapy; 214 were analysed at fourteen years.
- Recurrent above-knee reflux: 2.6 percent after stripping (1 of 38), 6.1 percent after laser (3 of 49), 30.8 percent after foam sclerotherapy (12 of 39).
- Re-intervention on the great saphenous vein: 13.2 percent after stripping, 8.2 percent after laser, 56.4 percent after foam sclerotherapy.
- Foam sclerotherapy carried a risk ratio for recurrent reflux of 11.7 against stripping and 5.0 against laser ablation.
- Stripping and laser ablation performed comparably to each other on both measures.
- Neovascularisation — new small vessels at the treated site — did not differ between treatments (29.0, 22.5 and 23.1 percent, P = .76).
- Quality of life at fourteen years did not differ between the three groups (overall P = .21).
Most figures quoted for varicose vein recurrence come from follow-up at one, two or five years. Veins recur over decades, so those numbers describe the beginning of the answer. A Finnish randomised trial went back to its patients after fourteen years, and the result splits into two halves that point in opposite directions.
The recurrence rates differ enormously
| Stripping | Laser ablation | Foam sclerotherapy | |
|---|---|---|---|
| Recurrent above-knee reflux | 2.6% | 6.1% | 30.8% |
| Re-intervention on the vein | 13.2% | 8.2% | 56.4% |
| Neovascularisation | 29.0% | 22.5% | 23.1% |
So the honest answer to whether veins come back is that it depends far more on which procedure was done than on anything about the patient. Foam sclerotherapy sent more than half of its patients back for another procedure inside fourteen years. Laser ablation sent fewer than one in twelve.
And then the quality of life was the same
Which one matters more is a question about the patient, not about the vein. Somebody who would find a second and third procedure an ordinary inconvenience is choosing differently from somebody for whom another operation is a serious undertaking, and the trial cannot decide that for either of them.
What to ask before the procedure
The useful question is not "will it come back" but "what is the fourteen-year re-intervention rate for the specific procedure you are proposing". Stripping and laser ablation came out comparable to each other on both recurrence and re-intervention; foam sclerotherapy did not, and it is the technique most often described to patients as the least invasive option.
One further note on the numbers: the groups in this trial contained 38 to 49 patients each at fourteen years, so a single additional recurrence moves a percentage noticeably. The twelvefold gap is large enough to survive that; the difference between 2.6 and 6.1 percent is not.
Sources
- 1
Rahman T, Noronen K, Vähäaho S, Halmesmäki K, Venermo M
Fourteen year outcomes of a randomised controlled trial comparing endovenous laser ablation, high ligation and stripping, and ultrasound guided foam sclerotherapy for great saphenous varicose veinsEuropean Journal of Vascular and Endovascular Surgery 2026;72(3):533-540
doi:10.1016/j.ejvs.2026.01.056 · PMID:41633433
https://doi.org/10.1016/j.ejvs.2026.01.056 - 2
Shon S, Kim H, Kim HC, Cho S, Lee SH, Joh JH
National trend of the treatment for chronic venous diseases in Korea between 2010 and 2020Annals of Surgical Treatment and Research 2023;104(1):27-33
doi:10.4174/astr.2023.104.1.27 · PMID:36685771
https://doi.org/10.4174/astr.2023.104.1.27
Related
News · Varicose Veins
Three varicose vein treatments, followed for fourteen years. Recurrence differed twelvefold and quality of life did not differ at all
Foam sclerotherapy sent 56.4 percent of patients back for another procedure against 8.2 percent after laser. At fourteen years all three groups reported the same symptom scores — which makes the question what you are willing to count as a cost.
David Seo7 min read
News · Varicose Veins
Treat the tributary veins in the same sitting, or wait and see? Doing it at once cut re-intervention by two thirds
Six randomised trials, 432 patients. The combined approach reduced the chance of needing another procedure to a third, with no more complications — and the case for waiting survives anyway, for a reason the trials cannot measure.
Catherine Cho6 min read
FAQ · Varicose Veins
Is the glue treatment better than laser for varicose veins?
It closes the vein just as well and leaves less bruising and numbness. The events that actually separate the two are too rare for a study of 7,844 patients to see.
David Seo5 min read