Background: Most studies of recurrent varicose veins have been based o
n the findings clinically, at operation, or on phlebography. Occasiona
lly these findings have been compared with Doppler findings produced b
y hand-held continuous-wave Doppler. Duplex scanning is a more refined
approach to the assessment of recurrent varicose veins. Methods: 202
patients (267 legs) have been examined consecutively for recurrent var
icose veins between January 1990 and December 1995 at St George Vascul
ar Laboratory. This was a retrospective study of some aspects and patt
erns of recurrence of varicose Veins in this group. Results: The ratio
of female to male was 3:1. The mean age of the group was 52 years and
mean time to recurrence was 13 years (1 year 95% CI). There were six
patterns of recurrence accounting for 95.2% of legs. In descending ord
er of frequency, these were: (i) the saphenofemoral junction and long
saphenous vein were intact and incompetent (44.6%); (ii) an incompeten
t thigh perforator and long saphenous vein remained intact; there was
no saphenofemoral junction (16.5%); (iii) the long saphenous vein rema
ined intact and incompetent; there was no saphenofemoral junction (10.
5%); (iv) there was an incompetent saphenofemoral junction only (9.74%
); (v) there was an intact and incompetent saphenopopliteal junction a
lone (9.74%); and (vi) an isolated thigh perforator was incompetent, w
ith no more proximal site of incompetence detected (4.12%). Incompeten
t calf perforator (69.2%) and gastrocnemius veins (9.3%) were frequent
ly detected, but rarely existed in isolation (seven legs in total). Co
nclusions: Duplex scanning is an important recent adjunct to the manag
ement of recurrent varicose veins in order to define the 'pathway of i
ncompetence'. The saphenofemoral junction and long saphenous vein rema
in the key to recurrence of varicose veins. Calf perforator and gastro
cnemius vein incompetence are of secondary importance in recurrent var
icose veins.