Identifying sources of recurrence and appropriate therapeutic options . BY EDWARD G . MACKAY , MD Treatment of Recurrent Varicose Veins

V aricose veins are largely treated by changing the circulatory pattern created by the underlying valvular failure. This frequently involves disconnecting superficial and deep connections that have incompetent valves to stop the flow from high-pressure deep veins back into low-pressure superficial veins and then ablating the damaged superficial veins (varicosities) either surgically, chemically, or thermally. Because there are numerous connections from superficial to deep veins (perforators) that could potentially fail,1 recurrence should be less of a surprise than the lack thereof. Good treatment necessitates the identification of these abnormal connections, which requires imaging that both identifies the perforator and demonstrates the abnormal flow. The use of duplex ultrasound has greatly improved the accuracy of identifying the problematic perforator, the most common being the saphenofemoral junction.