1. Inadequate evaluation of the underlying veins: This can only be adequately done with a Duplex Ultrasound that enables very precise measuring of blood flow in the deeper veins and clearly shows connections of any underlying problem with what is seen on the surface. If these underlying problems are not initially identified and treated any treatment of the surface problem will be doomed to failure.
2. Inadequate treatment of feeder veins (reticular veins) when spider veins (telangiectasia) are treated: This is the most common problem that I see and unfortunately results in the complication of matting and early recurrence.
3. Wrong treatment method: What I mean by this is often that surgery (“stripping”) is done for the treatment of varicose veins rather than the more effective and less invasive methods of Ultrasound Guided Sclerotherapy (UGS) or Endovenous Laser Ablation (ELA)
4. Inadequate follow-up: No matter who treats veins or how they are treated ALL treatments should be followed up to confirm that the treatment was effective and that it has stood the test of time. Ideally for UGS and ELA this follow-up should be done within 2 weeks of initial treatment and then roughly at 6 weeks and 12 months after the initial treatment.