1. Technical Causes – Related to your operation:
- Improper Planning of the Procedure : Your treatment starts from the planning stage when you undergo Venous Doppler Ultrasound that maps all the various veins that are causing your problem. Our Consultants at the Vein Center are trained in Vascular Ultrasound and perform this test themselves. This helps in proper planning so that the procedure can be executed in its entirety. The Vein Center, in our College of Phlebology, UK’s award-winning presentation on Treating Recurrent Varicose Veins deals with identifying the most common cause of recurrence of varicose veins. We identified the veins that are commonly missed during treatment and treating these heals venous disease. Looking for other causes of varicose veins like chronic deep venous thrombosis and other venous obstructive conditions also changes the treatment plan.
- Improper Execution of the Prepared Plan : In the South Asian scenario, typically Ultrasounds are done at a separate Diagnostic Center or Department which generated a report which is conveyed to the operating surgeon. This invariably causes a loss of information as it is relayed from one place to the other. As the operator is not actively involved in planning the procedure, some veins can be missed out leading to a suboptimal outcome. Other technical factors like non uniform tumescent anaesthesia injection, using sclerosing agents that are not efficient in ablating veins.
- Carrying out Outdated Procedures : Procedures like vein ligation surgeries have a very high recurrence rate and have been replaced by the latest heat ablation techniques. There are various older heat ablation techniques that are still carried out, like the earlier generation lasers, using bare fiber lasers etc.
2. Patient Related Factors:
- Persistence of Risk Factors : If patients continue to have the same risk factors that caused the disease in the first place, like standing for long periods of time, obesity, smoking etc, then there will be an increased risk of recurrence.
- Development of New Varicose Veins : This is called neovascularization – this means the development of new nonfunctioning veins around the site of the previous procedure. This is commonly seen after stripping and ligation procedures.
What does this mean in terms of your treatment ? How does it affect your care ?
We at The Vein Center are on a continuous mission to offer better care and make better protocols to treat varicose veins such that a recurrence is prevented and if there is a recurrence then it is caught early. We perform our own ultrasound so that your care each patient gets their personalized treatment plan. The team that planned the procedure also executes it – thus there is no loss of information. All our patients get a regular follow up ultrasound schedule which helps in catching a recurrence early.
Why is planning necessary?
This 60 year old gentleman who was previously treated for a venous ulcer on the heel by ligation and stripping of the GSV but the ulcer never healed. We did the doppler ourselves and found that he has an incompetent SSV and ankle perforating veins. This is how his ulcer healed.