Analysis of 436 recurrent varicose veins shows that the main cause is an inadequate operative technique that fails to ligate the saphenous veins flush to the femoral or the popliteal veins. The recurrence may also be due to a faulty diagnosis that over looks an incompetent short saphe nous vein or incompetent perfora tors. A careful clinical examination and complete investigation through echography and venography are needed. Reoperation should be per formed in order to obliterate all the points of reflux. The surgical approach to the re maining stump of a saphenous vein is very difficult through dense scar tis sue and lymph nodes closely adherent to the recurrent veins, which are fragile and thin-walled. It is a real challenge to the surgeon and requires a great deal of experience and opera tive skill.