Clinical and Imaging Characteristics and Short-Term Outcomes in Patients with Recurrent Varicose Veins: A Single-Center Descriptive Retrospective Study

Background: The reported postoperative recurrence rates of lower limb varicose veins differ considerably across studies, ranging from 7% to 62%. This study aimed to characterize the clinical and imaging findings in patients presenting with recurrent varicose veins (RVVs) and to describe short-term clinical outcomes after individualized reintervention. Methods: We enrolled 99 patients (114 lower extremities) with RVVs admitted from January 2018 to June 2025. All patients underwent duplex ultrasound scanning; computed tomography venography or magnetic resonance venography was performed to assess iliac vein anatomy. We analyzed the charts of patients for the prevalence of imaging and clinical abnormalities among patients with RVVs. This study was designed as a descriptive retrospective case series without a non-recurrent control group. We analyzed the distribution of venous abnormalities among the included limbs. Results: The mean patient age was 63.9 ± 9.8 years, and 71.7% of the patients were female. Among the 114 affected limbs, residual great saphenous vein trunks were identified in 55 (48.3%), deep venous reflux in 47 (41.2%), incompetent perforating veins in 7 (6.1%), anterior accessory great saphenous vein reflux in 2 (1.8%), and small saphenous vein reflux in 2 (1.8%). Iliac vein stenosis was suspected in 42 limbs, of which 38 underwent digital subtraction angiography; nonthrombotic iliac vein compression lesions were confirmed in 31 limbs. Confirmed lesions were more frequent in left-sided than right-sided RVVs limbs (35.8% vs. 16.3%; p = 0.03). The median venous clinical severity score decreased from 7 (interquartile range, 5–10) at admission to 2 (interquartile range, 2–3) 6 months after discharge (p < 0.01). All 20 active venous ulcers healed during follow-up. Conclusions: Residual great saphenous vein trunks, deep venous valve insufficiency, and nonthrombotic iliac vein compression lesions were frequently observed venous abnormalities in this retrospective descriptive case series of patients with RVVs. Comprehensive multimodal venous imaging may assist individualized reintervention planning. These findings describe a referred recurrent case series and cannot be interpreted as risk factors for recurrence without a non-recurrent control group. Long-term outcomes require further investigation.