Recurrence of varicose veins is a common problem. Four main reasons for recurrence are discussed: insufficient understanding of venous anatomy and haemodynamics, inadequate preoperative assessment, incorrect or insufficient surgery and development of new locations of superficial-to-deep insufficiency. Better insight in the variable anatomy of the venous system and better training of junior surgeons in this matter may improve the results of venous operations. Accurate preoperative assessment using (colour) duplex sonography should permit the surgeon to give the patient a differentiated, individualized treatment. Careful dissection of the saphenofemoral junction combined with additional stripping of the long saphenous trunk to just below the knee appears to be the best way to prevent recurrence from the long saphenous vein in the thigh. Concerning the short saphenous vein preoperative location of the exact level of the saphenopopliteal junction is of major importance in the prevention of recurrence. In this way, all diagnostic and surgical efforts should aim to minimize recurrence to about only 5% of patients.