What is the most common cause of recurrent varicose veins?

Incompetent perforator reflux is recognized as the most common cause of recurrent varicose veins due to its role in venous insufficiency. When perforating veins that connect the superficial and deep venous systems are incompetent, blood can flow in the wrong direction, typically from the deep venous system into the superficial system. This misdirection of blood flow exacerbates the already existing weaknesses in the superficial veins, leading to the development of new varicosities or the recurrence of previously treated varicose veins.

The significance of perforator veins lies in their function; they should normally prevent backflow by acting as one-way valves. If these valves fail, it can contribute to increased venous pressure and further venous distension, causing the veins to become engorged and develop into varicose veins. This understanding is critical for effective treatment and management of patients with venous insufficiency and varicose veins.

Other conditions, while they can contribute to venous disease, do not account for the high recurrence rates observed in varicose veins as frequently or directly as incompetent perforator reflux does. This makes it essential for healthcare providers to evaluate the competency of perforating veins when addressing recurrent varicose veins in patients.