Patterns of recurrent varicose veins after surgery (REVAS): A systematic review and network meta-analysis of randomized trials.

In 30 seconds

This systematic review and network meta-analysis examined recurrence patterns after treatment of primary saphenous vein insufficiency, using 23 randomized trials of eight procedural modalities with at least 1-year follow-up. Recurrence differed by anatomical site and treatment. Saphenofemoral junction recurrence was 23.6% overall; compared with high ligation and stripping (HLS), its risk was higher after endovenous laser ablation (EVLA; risk ratio 2.29, 1.40–3.76) and foam sclerotherapy (FS; 2.09, 1.20–3.62). Endovenous methods had less neovascularization, while FS had more recanalization. Only 13% of trials reported recurrence using REVAS.

Key findings

• Cumulative recurrence was 23.6% at the saphenofemoral junction, 7.6% at thigh perforators, and 4.7% at lower-leg perforators.
• Compared with HLS, saphenofemoral junction recurrence risk was higher with EVLA (2.29, 1.40–3.76) and FS (2.09, 1.20–3.62).
• FS had higher recanalization risk than HLS (4.05, 2.23–7.35) and EVLA (3.14, 1.82–5.41).
• EVLA and FS were associated with lower neovascularization risk than HLS (0.28, 0.18–0.43 and 0.18, 0.08–0.40, respectively); only 13% of trials used REVAS reporting.

Why it matters

Recurrence is not a single outcome: its anatomical source and mechanism vary across procedures. These findings help frame comparisons of treatment durability and highlight that inconsistent classification can obscure clinically relevant differences. More complete reporting of recurrence patterns could improve interpretation of trial outcomes and support clearer assessment of technical results.

What to keep in mind

Only 13% of included randomized trials reported recurrence using REVAS, limiting consistent classification and comparison of recurrence patterns.