Assessment of the Risk of Recurrence of Lower Extremity Varicose Vein Disease After Endovenous Procedures

Objective: To evaluate the risk of recurrence of lower extremity varicose disease (LEVVD) after endovenous procedures based on identified risk factors and a developed scoring system.

Materials and methods: A retrospective analysis was performed of 1,647 medical records, including inpatient case histories and outpatient charts of patients with LEVVD. All patients underwent endovenous procedures on the main trunks of the superficial veins, including additional treatment of tributaries.

In patients with recurrence, clinical and demographic data, results of instrumental and laboratory investigations, pharmacotherapy, and characteristics of surgical intervention were analyzed in detail. Based on the identified factors, a scoring system for assessing the risk of recurrence of LEVVD after endovenous interventions was developed. The validity of this scale was tested in the entire cohort of patients included in the retrospective analysis. Data processing was performed using SPSS version 25 and Microsoft Excel.

Results: The following risk factors for recurrence of lower extremity varicose disease (LEVVD) after endovenous surgery were identified: age over 65 years; body mass index (BMI) greater than 34 kg/m²; history of type 2 diabetes mellitus (with glycated hemoglobin level above 8%); chronic heart failure of functional class II or higher; persistent incompetent perforating veins of the thigh and lower leg; diameter of functioning tributaries: greater than 3 mm in the thigh and greater than 5 mm in the lower leg; diameter of the functioning anterior tributary of the great saphenous vein (GSV) greater than 3 mm; diameter of the Giacomini vein greater than 3.5 mm; residual stump of the GSV at the saphenofemoral junction >1 cm; laser ablation parameters: power up to 7 W and energy density less than 80 J/cm²; and GSV trunk diameter greater than 8 mm.

According to the developed scoring system, the distribution of patients across risk groups was as follows: low risk 55.56% (n=915); moderate risk 40.62% (n=669); high risk 2.91% (n=48); and very high risk 0.91% (n=15).

At the same time, concordance between the predicted outcome based on the scale and the actual occurrence of recurrence (n=51) was observed in 80.95% of cases.

Conclusion: The scoring system for the quantitative assessment of recurrence of lower extremity varicose disease following endovenous interventions, developed on the basis of identified risk factors, demonstrated high prognostic value. The accuracy of the prediction is ensured by a comprehensive analysis of clinical and demographic data, results of instrumental and laboratory investigations, pharmacotherapy, and characteristics of the surgical intervention performed.

1. Chapagain D, Shrestha KP, Thapa Magar D, Shrestha KB, Yadav PK. Recurrence of Varicose Vein after Endovenous Laser Therapy in a Tertiary Care Center: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc. 2021;59(235):267-270. PMID: 34506441. PMCID: PMC8369548. https://doi.org/10.31729/jnma.6163

2. Krylov AYu, Shulutko AM, Khmyrova SE, Osmanov EG, Gogokhiya TR, Petrovskaya AA. Varicose Syndrome Correction in Complex Treatment of Lower Limb Varicose Veins. Journal of Venous Disorders. 2020;14(4):336-344. (In Russ.) https://doi.org/10.17116/flebo202014041336

3. Mikhailov I.P., Kozlovsky B.V., Arustamyan V.A. Surgical Treatment of Varicose Veins of the Lower Extremities. Russian Sklifosovsky Journal “Emergency Medical Care”. 2023;12(3):471-480. (In Russ.). https://doi.org/10.23934/2223-9022-2023-12-3-471-480

4. Nyamekye IK. European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. J Med Vasc. 2022;47(2):53-55. PMID: 35691663. https://doi.org/10.1016/j.jdmv.2022.04.003

5. Seliverstov EI. Epidemiology, pathogenesis and vein-preserving treatment strategy of lower extremity varicose vein disease. Dissertation abstract (Doctor of Medical Sciences). Moscow; 2021. 46 p. (In Russ.).

6. Wallace T, El-Sheikha J, Nandhra S, et al. Long-term outcomes of endovenous laser ablation and conventional surgery for great saphenous varicose veins. Br J Surg. 2018;105(13):17591767. PMID: 30132797. https://doi.org/10.1002/bjs.10961

7. Kheirelseid EAH, Crowe G, Sehgal R, et al. Systematic review and meta-analysis of randomized controlled trials evaluating long-term outcomes of endovenous management of lower extremity varicose veins. J Vasc Surg Venous Lymphat Disord. 2018;6(2):256-270. PMID: 29292115. https://doi.org/10.1016/j.jvsv.2017.10.012

8. O’Donnell TF, Balk EM, Dermody M, Tangney E, Iafrati MD. Recurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials. J Vasc Surg Venous Lymphat Disord. 2016;4(1):97-105. PMID: 26946904. https://doi.org/10.1016/j.jvsv.2014.11.004

9. Safonov V. A., Gromatsky D. F., Nenarochnov S. V., Sherov R. Z. Recurrence of varicose veins. Causes, methods of diagnosis and treatment. Bulletin of the Siberian Branch of the Russian Academy of Medical Sciences. 2013;33(3):46-51. (In Russ.).

10. Ruquaya, S. Predictors of Recurrent Varicose Veins: A Systematic Review of Risk Factors Contributing to Recurrence After Treatment. International Journal of Medical Science in Clinical Research and Review. 2025;8(2):109–115.

11. Sussman MS, Ryon EL, Bahga A, Almeida S, Almeida JI. A systematic review of the treatment of residual below the knee venous reflux after endovenous thermal ablation of the great saphenous vein. J Vasc Surg Venous Lymphat Disord. 2022;10(1):233240. PMID: 34425265. https://doi.org/10.1016/j.jvsv.2021.03.024

12. Nikogosian A., Maximkin D.A. Frequency and Causes of Recurrence after Endovenous Procedures in Patients with Varicose Vein Disease of the Lower Extremities. Innovative Medicine of Kuban. 2026;11(1):45-52. (In Russ.) https://doi.org/10.35401/2541-98972026-11-1-45-52

13. Khmyrova SE. Prediction of the risk of postoperative recurrence in patients with uncomplicated forms of lower extremity varicose vein disease. Dissertation (Candidate of Medical Sciences). Moscow; 2006. 103 p. (In Russ.)

14. Hu H, Hu L, Deng Z, Jiang Q. A prognostic nomogram for recurrence survival in post-surgical patients with varicose veins of the lower extremities. Sci Rep. 2024;14(1):5486. PMID: 38448552. PMCID: PMC10918178. https://doi.org/10.1038/s41598-02455812-0

15. Raskin VV, Semenov AYu, Kurginyan KhM. Endovenous laser obliteration in the prevention of recurrence of varicose veins in the anterior saphenous vein pool. Russian Journal of Preventive Medicine. 2020;23(3):98-103. (In Russ.) https://doi.org/10.17116/profmed20202303198

16. Zollmann M, Zollmann C, Zollmann P, Veltman J, Cramer P, Stüecker M. Recurrence types 3 years after endovenous thermal ablation in insufficient saphenofemoral junctions. J Vasc Surg Venous Lymphat Disord. 2021;9(1):137-145. PMID: 32361003. https://doi.org/10.1016/j.jvsv.2020.04.021

17. Nikolaev A.M., Kotaev A.Yu., Vakhrat’ian P.E., Chernookov A.I., Muraviev S.Yu., Berikkhanov Z.G., Atayan A.A., Savelieva V.A., Abasova Z.D. Anatomical variants of recurrent varicose veins of the lower extremity after endovenous laser ablation of the great saphenous vein. Ambulatornaya khirurgiya. 2024;21(2):52-59. (In Russ.) https://doi.org/10.21518/akh2024-040