In a surgical varicose vein practice 509 patients who had suffered recurrent varicose veins following surgery in other institutions were traced. The causes of recurrences were identified in a retrospective analysis and related to the source of primary treatment: in hospital treatment (n = 290), surgical practice (n = 56) or another varicose vein specialist (n = 104). A significant difference was noted between the three institutions in the use of saphenofemoral resection (78%, 63% and 97%) as well as greater saphenous vein stripping (44%, 14% and 0%). Lack of or insufficiently performed saphenofemoral surgery were identified as contributing to saphenofemoral insufficiency in 40% and 43% of patients primarily treated in hospital and in surgical practice, respectively, but only in 14% of those treated by a varicose vein specialist (p < 0.001). Primary sapheno-popliteal resection had been used equally infrequently (11%, 13% and 16%, respectively) and was equally frequently insufficiently performed (66%, 57% and 41%). This retrospective investigation concludes that insufficient varicose vein surgery is a major contributor to recurrences, particularly when primary surgery is performed in hospital or in surgical practice, as opposed to in a varicose vein practice. These results warrant a reorganisation of varicose vein surgery in Denmark.