Predictors of Recurrent Varicose Veins: A Systematic Review of Risk Factors Contributing to Recurrence After Treatment

Abstract

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  Background: Varicose veins are a common chronic venous disorder characterized by abnormally dilated, elongated, and tortuous veins, typically in the lower extremities. They result from valvular incompetence, which leads to retrograde blood flow, venous hypertension, and blood pooling, causing symptoms such as leg swelling, heaviness, pain, and skin changes. The condition significantly impacts patients’ quality of life, particularly among individuals with prolonged standing occupations or sedentary lifestyles. Despite advancements in treatment modalities, recurrent varicose veins (RVV) remain a significant challenge, leading to repeated interventions and increasing healthcare costs. Objective: This systematic review aims to identify key predictors contributing to recurrent varicose veins after treatment and evaluate their impact on long-term patient outcomes. Methods: A systematic literature search was conducted in PubMed, Scopus, and Web of Science using Boolean operators to refine search results. Inclusion criteria comprised studies evaluating predictors of varicose vein recurrence, while case reports, reviews, and studies with insufficient follow-up were excluded. Data extraction focused on patient demographics, treatment modalities, recurrence rates, and key risk factors. Bias was assessed using the Newcastle-Ottawa Scale (NOS) and the Cochrane Risk of Bias Tool. Results: Five studies were included after applying eligibility criteria. The main predictors of recurrence identified were: Venous reflux (persistent reflux post-treatment). High BMI (obesity leading to increased venous pressure). Incompetent saphenous vein (failure to address underlying venous hypertension). Genetic predisposition (hereditary influence on vein wall integrity). Lifestyle and occupational factors (sedentary behavior, prolonged standing, and non-adherence to post-treatment care). A PRISMA flowchart was used to illustrate the study selection process, while tables summarize recurrence predictors. Conclusion: Recurrent varicose veins result from multiple factors, including persistent reflux, obesity, untreated venous incompetence, genetic predisposition, and lifestyle factors. A multifactorial approach involving preoperative venous mapping, lifestyle modifications, and personalized treatment strategies is necessary to minimize recurrence rates and improve clinical outcomes.

  
  
  

  Keywords: Varicose Veins, valvular, elongated, and tortuous veins