Ligation Of Perforating Veins Research Articles

Minimaly Invasive Interventions in Acute Tributary Varicothrombophlebitis of the Lower Extremities

Background. One of the formidable complications of varicose veins of the lower extremities is thrombophlebitis. The risk of developing venous thromboembolic complications remains high even when taking anticoagulants. Most authors do not even consider surgical elimination of the manifestations of acute superficial thrombophlebitis. The aim. To evaluate the effectiveness of minimally invasive surgical treatment of acute tributary varicose veins of the lower extremities. Materials and methods. The surgical treatment of 78 patients with acute varicothrombophlebitis of the tributaries of the great saphenous vein was analyzed. Depending on the treatment performed, patients were divided into two groups: group I including 56 (71.8%) patients who underwent inpatient surgery for thrombotic lesions of varicose veins of the tributaries of the great saphenous vein; group II including 22 (28.2%) patients who received conservative outpatient treatment. Results. The choice of the volume of surgical intervention in patients of group I depended on the condition of thegreat saphenous vein. In the absence of thrombotic and varicose veins in 29 (51.8%) patients, the latter was preserved. With varicose changes in the great saphenous vein, 16 (28.6%) patients underwent radiofrequency ablation after ligationof the thrombosed tributary duct and miniphlebectomy or phlebocentesis with foam-form sclerotherapy. In 11 (19.6%) cases of thrombotic lesions of the great saphenous vein, crossectomy, long/short stripping or phlebocentesis with stem sclerotherapy after ligation of its tributaries and isolation of the latter distal to the thrombotic occlusion was performed. The surgical intervention was supplemented with miniphlebectomy of other varicose veins and ligation of failed perforator veins. In patients of group II, treatment was prescribed similarly to the treatment of deep vein thrombosis. Surgical treatment of patients in group I effectively prevented venous thromboembolic complications and reduced the manifestations of chronic venous insufficiency in 72.9% of cases. Conclusions. Minimally invasive surgical intervention for acute thrombophlebitis of the tributaries of the great saphenous vein allows, on an outpatient basis or in a one-day hospital, to eliminate thrombotic lesions of varicose super-ficial veins and prevent venous thromboembolic complications, reduce or eliminate manifestations of chronic venous insufficiency, prevent recurrence of thrombosis, and reduce the patient’s disability.

A COMPARATIVE STUDY BETWEEN SUBFASCIAL ENDOSCOPIC PERFORATOR LIGATION WITH OPEN SUBFASCIAL PERFORATOR LIGATION FOR TREATMENT OF VARICOSE VEINS.

Background: Varicose veins is a common problem present in at least 10% of the general population and 5% in India. Subfascial endoscopic perforator surgery is a minimally invasive approach for ligation of abnormal perforator veins under the muscle fascia of the legs. Aim: To compare subfascial endoscopic perforator surgery with open perforator legation in the treatment of varicose veins. This prospective study comprised of 60 patients with varicose ve Materials And Methods: ins. Of the 60 cases, 20 cases underwent subfascial endoscopic perforator surgery and 40 Patient underwent Open subfascial perforator surgery. The operative time for Result: subfascial endoscopic perforator surgery was less than that of open subfascial perforator surgery. Improvement in the skin pigmentation, aedema, ulcer healing was better with subfascial endoscopic perforator surgery. The recurrence rate was found to be 30% with open subfascial perforator ligation whereas it was 0% with subfascial endoscopic perforator surgery. Subfas Conclusion: cial endoscopic perforator surgery is easy, technically efcient, has less operative time, better healing of ulcer and low recurrence.

Detection of residual varicose veins with near infrared light in the early period after varicose surgery and near infrared light assisted sclerotherapy.

Varicose veins that cannot be seen with the naked eye can be easily detected with Near Infrared (NIR) light. With a minimally invasive procedure performed with NIR light guided, the need for reoperation is reduced, while optimal treatment of venous insufficiency and symptoms is provided. In this study, the detection of residual varicose veins after varicose vein surgery using NIR light and the results of treatment of sclerotherapy were investigated. In this retrospective study, treatment and clinical outcomes of patients' who underwent NIR light-guided foam sclerotherapy for Clinical-Etiology-Anatomy-Pathophysiology (CEAP) (C1, C2) stage residual varicose veins after surgical varicose treatment between 2014 and 2017 were examined. Data of patients who underwent foam sclerotherapy with NIR light were collected and analyzed. A total of 151 patients and 171 lower extremity varicose veins were treated with surgery. 55 (35.7%) of the patients were male, and 96 (62.3%) were female. Their age ranges from 20 to 64, with an average age of 45.38. 4 (2.6%) of the patients had phlebectomy. 137 of patients (90.7%) had ligation of perforated veins, phlebectomy, and great saphenous vein (GSV) stripping, 10 of patients (6.6%) had GSV stripping, perforating vein ligation, phlebectomy, and small saphenous vein (SSV) surgery. No residual leakage was observed in the controls of GSV, SSV, and perforating veins by duplex ultrasonography (DUS). In the first month after varicose surgery, an average of 1.64 ± 1.05 sessions of sclerotherapy was applied to patients with CEAP C1, C2 stage residual varicose veins. 70 patients had one session of sclerotherapy, 37 patients had two sessions of sclerotherapy, 20 patients had three sessions of sclerotherapy, and 11 patients had four sessions of sclerotherapy administrated. The need for complementary therapy was required for all female patients; 13 of the male patients did not require complementary sclerotherapy. While single-session sclerotherapy was applied to most male patients (32 (58.18%), 10 (18.18%) patients received two sclerotherapy sessions. After completing sclerotherapy, 7 (4.63%) patients had superficial venous thrombosis, and 13 (8.60%) patients had hyperpigmentation. Surgical treatment is a safe and effective technique in venous insufficiency. Nevertheless, residual varicose veins may remain, and these can be detected noninvasively with NIR light. Foam sclerotherapy with NIR light is a minimally invasive and safe treatment method for small residual varicose veins after the operation. We think that sclerotherapy with NIR light as a complementary treatment is a practical, reliable, and demanding treatment for clinical improvement, especially in female patients.

Our experience with subfascial perforator vein ligation by Cockett and Dodd in perforator incompetence of varicose veins

Our experience with subfascial perforator vein ligation by Cockett and Dodd in perforator incompetence of varicose veins

The Role of Subfascial Ligation of Perforator Veins By Cockett And Dodd Method in the Treatment of Varicose Veins

The Role of Subfascial Ligation of Perforator Veins By Cockett And Dodd Method in the Treatment of Varicose Veins

Leg Venous Ulcer Size Inversely Related to Number of Notable Perforating Veins: A Word of Caution

Background Perforating vein ligation has been proposed for the treatment of chronic venous ulcers in the leg. Pubmed.org , however, showed a lack of increase in subfascial endoscopic perforator surgery (SEPS) publications, even before the popularization of perforating vein thermal or chemical ablation procedures. We renewed an investigation on perforating vein ligation surgery as part of venous ulcer treatment. The basic question was if ulcer size and number of notable perforating veins were related. Methods Leg perforating veins were detected by ultrasonography (US) and by clinical palpation in 118 legs of 104 subjects, mostly women (79, 76%). This group represented a sample of a mostly rural Brazilian population. Inclusion criterion was any “request for venous US at any stage of ulcer treatment.” Ulcer size in centimeters squared and number of detected perforating veins (NP) were compared using Pearson correlation coefficient p available with Excel. Results Average ulcer size was 13 ± 17 cm2 (1–100) for NP = 0–7, resulting in p = −0.18 for the 118 pairs of data. Subgroup averages were 16, 16, 11, 8, and 8 cm2 for NP = 0, 1, 2, 3, and ≥4 perforating veins detected (n = 32, 30, 29, 16, and 11, respectively), resulting in p = −0.94 for such averages and NP. Conclusion Ulcer size failed to correlate with number of detected perforating veins based on raw data but correlated inversely to such number if subgroup averages were compared. Average ulcer size was larger for subgroups of legs with lesser number of perforating veins. Arbitrary ligation of detectable perforating veins may result in ulcer size augmentation. Detailed research must continue to find criteria to indicate (a) ligation or (b) preservation of specific perforating veins either (a) detrimental or (b) contributory to venous ulcer healing.

Influence of the Angle of Anastomosis on the Patency of Arteriovenous Fistulas for Hemodialysis

Objectives: The surgery of the varicose veins under tumescent local anesthesia is not very widespread. We sought to evaluate the feasibility and the short-term results of this technique. The patient filled follow-up questionnaires by connecting on a secure server via his email. Materials and Methods: This twin centers prospective study relating to 603 patients and 707 interventions was conducted from January 1st to December 31st, 2014. All the patients operated for varicose veins under tumescent local anesthesia with or without sedation and having a valid email address were included. The collection of the postoperative data was carried out using dedicated software sending the questionnaires to the patients from D0 till D7, then at D15 and D30 about their pain, bleeding, functional capacity and satisfaction. Results: The population comprised 72.8%of women, with amean age of 51 years and a BMI of 24.4. Recurrence was present in 24.2% of the patients. The average score of clinical severity (VCSS) was 4.5/30, the preoperative pain reached 2.53 on an analogical visual scale (AVS) and the CEAP was: C11⁄41%, C21⁄453%, C31⁄414%, C41⁄46%, C51⁄40.7%, C61⁄40.6%. A local anesthesia without any sedation was carried out in 79%of the cases. Amean of 20 phlebectomies was carried out. The additional procedures were: crossectomy in 15% of the cases, stripping in 19%, radio frequency in 26%, laser in 3%, foam sclerotherapy in 10%, embolization in 0.4%, perforating vein ligation in 0.3%, and redo crossectomy in 0.7%. No peroperative complication resulted in stopping the procedure. At D0 and D1 the rates of respondents were 66% and 57%, respectively. The average AVSwas 1.73 and 1.24, respectively. The activity was regarded as normal or subnormal in respectively 85% and 93% of the cases. 99.6% of the patients were satisfied or very satisfied at D0. At D30, we observed 0.1% of infection, 0.3% of superficial venous thrombosis, no major venous thrombosis, no hematoma, no lymphorrhea, and 0.1% of neurological complications. Conclusion: The surgery of varicose veins under tumescent local anesthesia with or without sedation can be carried out without risk. It gives excellent immediate results in terms of pain, functional recovery and satisfaction without major complications. The data-processing tool for evaluation we used seems to be a mode of collection of medical data extremely useful and reliable.

Prospective Follow-up of 709 interventions for Varicose Veins Carried out Under Tumescent Local Anesthesia Using Innovating Computer Software of “patient Follow-up”

Objectives: The surgery of the varicose veins under tumescent local anesthesia is not very widespread. We sought to evaluate the feasibility and the short-term results of this technique. The patient filled follow-up questionnaires by connecting on a secure server via his email. Materials and Methods: This twin centers prospective study relating to 603 patients and 707 interventions was conducted from January 1st to December 31st, 2014. All the patients operated for varicose veins under tumescent local anesthesia with or without sedation and having a valid email address were included. The collection of the postoperative data was carried out using dedicated software sending the questionnaires to the patients from D0 till D7, then at D15 and D30 about their pain, bleeding, functional capacity and satisfaction. Results: The population comprised 72.8%of women, with amean age of 51 years and a BMI of 24.4. Recurrence was present in 24.2% of the patients. The average score of clinical severity (VCSS) was 4.5/30, the preoperative pain reached 2.53 on an analogical visual scale (AVS) and the CEAP was: C11⁄41%, C21⁄453%, C31⁄414%, C41⁄46%, C51⁄40.7%, C61⁄40.6%. A local anesthesia without any sedation was carried out in 79%of the cases. Amean of 20 phlebectomies was carried out. The additional procedures were: crossectomy in 15% of the cases, stripping in 19%, radio frequency in 26%, laser in 3%, foam sclerotherapy in 10%, embolization in 0.4%, perforating vein ligation in 0.3%, and redo crossectomy in 0.7%. No peroperative complication resulted in stopping the procedure. At D0 and D1 the rates of respondents were 66% and 57%, respectively. The average AVSwas 1.73 and 1.24, respectively. The activity was regarded as normal or subnormal in respectively 85% and 93% of the cases. 99.6% of the patients were satisfied or very satisfied at D0. At D30, we observed 0.1% of infection, 0.3% of superficial venous thrombosis, no major venous thrombosis, no hematoma, no lymphorrhea, and 0.1% of neurological complications. Conclusion: The surgery of varicose veins under tumescent local anesthesia with or without sedation can be carried out without risk. It gives excellent immediate results in terms of pain, functional recovery and satisfaction without major complications. The data-processing tool for evaluation we used seems to be a mode of collection of medical data extremely useful and reliable.

Is color Doppler ultrasound-assisted perforating vein ligation with a mini-incision still a viable alternative?

Is color Doppler ultrasound-assisted perforating vein ligation with a mini-incision still a viable alternative?

Leg ulcer treatment

Venous ulcers continue to cause problems for patients and health care systems. These are painful and unpleasant for the patient and expensive for health care providers to treat. This brief review highlights effective methods of management. There is level 1 evidence of the efficacy of compression (bandaging or stockings) in healing ulcers as well as maintaining healing. Patients with superficial saphenous reflux, with or without perforating and deep vein incompetence, benefit from superficial venous surgery. This does not speed ulcer healing but is effective at preventing recurrence after healing with compression. Minimally invasive methods of managing incompetence of superficial saphenous trunks, including endovenous laser ablation, radiofrequency ablation, and foam sclerotherapy are probably also effective in treating patients with venous leg ulcers. Perforating vein ligation is commonly combined with superficial venous surgery for leg ulcer patients, but no systematic data are available to define the role of this treatment. Some centers use deep vein reconstruction to restore competence to deep vein valves. Insufficient data have been published to allow any general recommendation to be made for this treatment. A limited number of drugs have efficacy in promoting leg ulcer healing. They may be used in combination with compression treatment in patients with ulcers refractory to other methods of management. No particular ulcer dressing has been shown to be effective in speeding ulcer healing.

Side-to-side arteriovenous fistula at the elbow with perforating vein ligation

We postulated that ligation of a consistent perforating venous branch at the elbow would improve distention and flow in the superficial veins about the elbow. This would also lesson the likelihood of arterial steal enabling a favorable outcome following a brachial artery medial antecubital or cephalic vein arterio-venous fistula (AVF). Pressure measurements were made from the radial artery after side-to-side brachial artery antecubital or cephalic vein AVF in 20 patients. Clamping of the perforating vein increased radial artery pressure significantly indicating that a considerable amount of flow from the side-to-side AVF was diverted into the deep system and away from the accessible superficial veins. Encouraged by this finding, we studied the outcome of brachial cephalic or brachial antecubital AVF with ligation of the deep branch in 134 patients who were not candidates for radio-cephalic AVF. The end point of the study was successful hemodialysis using the fistula. Of the 134 patients treated, 24 died, and 11 were lost to follow-up and were censored from analysis of fistula performance at that time point. The primary fistula success rate was 89.7% +/- 2.66% and 83.7% +/- 3.5% at 1 and 2 years by life table analysis. No patient developed significant arterial steal or venous hypertension. We recommend this simple one-stage procedure for patients requiring hemodialysis whose cephalic vein at the wrist is unsuitable.

Recurrent Varicose Veins Following Surgical Treatment: Our Experience with Five Years Follow-up

To report the 5 year outcome of varicose veins surgery and to establish the factors determining recurrence. Prospective observational study. This study reports the outcome in 1326 patients treated in a day surgery centre of an institutional referral centre. Patients were investigated clinically and by colour flow duplex scanning before operation. Treatments used included flush ligation of the sapheno-femoral junction (SFJ) and the sapheno-popliteal junction (SPJ). Incompetence of the great saphenous vein (GSV) and small saphenous vein (SSV) were managed by stripping of these veins. Perforating vein ligation and hook phlebectomy were also used. Patients were evaluated 3 weeks and 5 years following treatment by clinical examination and duplex ultrasonography. 412 patients were excluded from the study because they failed to attend for follow-up or did not wear elastic stockings post-operatively. No residual saphenous truncal reflux was found at the initial assessment 3 weeks following surgery. After 5 years, recurrence of varicose veins occurred in 332 patients out of 1326 (25 %). Recurrences arose at the sapheno-femoral junction in 109 out of 862 patients (13%), at the sapheno-popliteal junction in 39 out of 132 patients (30%), in both saphenous regions 38 out of 107 patients (36%) and in 146 out of 225 subjects (65 %) with secondary varicose veins. Varicose veins recurred despite technically correct surgery confirmed on post-operative duplex ultrasonography. The likelihood of recurrence increased in the presence of SSV reflux, perforating vein incompetence and post-thrombotic deep vein incompetence.

Early changes in the post-phlebitic limb: their clinical significance.

Abstract The long-term results of treatment of the established post-phlebitic syndrome by compression sclerotherapy or by ligation of incompetent perforating veins were unsatisfactory in approximately 40 per cent of patients. Changes in superficial venous pressure during exercise occurred when the deep veins were recanalized and the perforating veins became incompetent. These pressure changes could be used to select patients likely to develop the full syndrome. It is suggested that development of an intractable syndrome might be prevented if ligation of incompetent perforating and deep veins is performed before tissue changes become established.

The place of subfascial ligation of perforating veins in the treatment of the post-phlebitic syndrome.

Abstract Subfascial ligation of incompetent perforating veins was employed in the treatment of 103 patients. The patients were selected on clinical grounds and the existence of perforating veins was established by phlebography. The description of the technique employed stresses details contributing to safe and rapid healing when a radical exploration is performed through skin and subcutaneous tissues of poor vitality. The role of subfascial ligation in the treatment of the post-phlebitic syndrome is to control the disordered venous return consequent on obstruction of the calf-muscle pump. As such, the procedure is one part of the treatment of the limb as a whole.

Foot volumetry and duplex ultrasonography after saphenous and subfascial perforating vein ligation for recurrent venous ulceration.

Forty-three patients undergoing superficial and perforating vein ligation for recurrent venous ulceration underwent preoperative and postoperative foot volumetry and postoperative duplex ultrasonography. Patients were followed for a median of 66 (range 18-144) months. Of nine patients who developed recurrent ulceration, six had femoral vein incompetence and all had popliteal vein incompetence demonstrated by duplex ultrasonography. Of the 34 patients who remained ulcer-free, five had femoral vein incompetence and a single patient had popliteal vein incompetence on duplex scanning, giving positive predictive values for recurrent ulceration of 55 per cent (femoral vein incompetence) and 90 per cent (popliteal vein incompetence). Patients with saphenofemoral incompetence on late follow-up were also more likely to suffer recurrence. Preoperative foot volumetry with tourniquet occlusion of superficial veins showed that the median expulsion fraction of patients who developed recurrent ulcer during follow-up was 0.8 (range 0.6-2.3) per cent compared with 1.5 (range 0.4-2.9) per cent for those who remained ulcer-free (P = 0.025); the median half-refilling time of patients with recurrent ulcer was 1.5 (range 0.5-5.5) s compared with 5.0 (range 0.5-23.0) s for those without recurrence (P < 0.01). Postoperative foot volumetry showed similar differences. Deep venous incompetence, particularly of the popliteal segment, as demonstrated by duplex ultrasonography and foot volumetry, is a useful predictor of recurrent ulceration after subfascial perforator and superficial venous ligation.

Spinal Epidural Hematoma after Spinal Anesthesia in a Patient Treated with Clopidogrel and Enoxaparin

Spinal Epidural Hematoma after Spinal Anesthesia in a Patient Treated with Clopidogrel and Enoxaparin

Closed Subfascial Ligation of Incompetent Perforating Veins of the Lower Extremities

The purpose of this study was to determine the effectiveness of minimally invasive surgical procedures for interrupting incompetent perforating veins of the lower limb. A closed subfascial ligation was performed in 20 patients who had incompetent perforating veins in 28 limbs as diagnosed by a clinical examination and duplex scanning. Two small transverse incisions measuring 5-10 mm in length were made on both sides of the incompetent perforating vein. Using an aneurysmal needle, a suture (polypropylene No. 1) was placed in the subfascial plane to encircle the incompetent perforating vein from all directions. Next, this suture was tied through two incisions to ligate this perforator. The mean follow-up period was 26 months. The ligation of the incompetent perforators was successful in 27 of 28 limbs and no wound complications were observed. A closed subfascial ligation of incompetent perforating veins of the lower limbs is thus considered to be easy to perform, not overly invasive, safe, and to also have very encouraging results.

Treatment of severe chronic venous insufficiency using the subfascial endoscopic perforator vein procedure

Before 1985, corrective surgical procedures for patients with chronic venous insufficiency and venous ulcers were performed using long incisions through diseased skin and subcutaneous tissues. The procedure, involving ligation of incompetent perforator veins, known as "the Linton operation," often was complicated by wound infections and poor healing. This changed in 1985 when G. Hauer demonstrated a new surgical technique for direct visual identification of the incompetent perforator veins using an endoscope in the subfascial space. This seminal contribution marked the advent of subfascial endoscopic perforator vein surgery (SEPS). From 1996 to 2004, the authors group prospectively collected data on 110 patients with chronic venous insufficiency who underwent a SEPS procedure. Preoperative assessment of the limb's vascular status consisted of color-flow duplex ultrasound imaging and ascending and descending phlebography to locate vein valve incompetence, along with venous mapping. The ages of the patients ranged from 42 to 82 years (mean, 60 years). A total of 128 limbs underwent the SEPS procedure in the cohort of 110 patients. According to CEAP classification for venous limb disease, 60 limbs belonged to group C5 (skin changes, pigmentation, venous eczema, lipodermatosclerosis, healed ulcer) and 68limbs to group C6 (skin changes and active ulceration). The 110 patients underwent 128 SEPS procedures without significant morbidity. Of the 68 limbs in class C6, 54 showed ulcer healing within the follow-up period of 12 weeks. The remaining 14 limbs in class C6 achieved ulcer healing within 24 weeks. In this latter group, 10 patients had venous ulcers larger than 4 cm in diameter. These patients underwent a split-thickness skin graft at the time the SEPS procedure was performed. The grafts remained healed during a 2-year follow-up period. This study demonstrated the effectiveness of the SEPS procedure when incorporated into the overall treatment strategy for patients with chronic venous insufficiency. Minimal postoperative complications accompanied by ulcer healing and relief of lower extremity symptoms were achieved for all the patients, underscoring the important role of incompetent perforator veins in the formation of chronic venous insufficiency.

The evaluation for the therapeutic effect and the clinical practicability of encircling constriction of superficial femoral vein in the treatment of primary deep venous insufficiency

To evaluate the therapeutic effect and the clinical practicability of encircling constriction of superficial femoral vein in the treatment of primary deep venous insufficiency (PDVI). Ninety-seven limbs in 97 patients who were proved to be PDVI by ascending venography were divided into Group A (79 limbs) and Group B (18 limbs). Patients of Group A were treated with the encircling constriction of venous wall at the first valve of superficial femoral veins. And they were also treated with the high ligation and ablation of great saphenous vein, ablation of superficial veins and ligation of perforator veins at the same time. Patients of Group B were simply treated with the high ligation and ablation of great saphenous vein, ablation of superficial veins and ligation of perforator veins. Ascending venography and CEAP classification and clinical scoring were proceeded from two months to six years after operation to evaluate the effect of the operation. The difference between preoperative and postoperative scores of Group A and Group B were both remarkable (Group A, P < 0.01; Group B, P < 0.05). The difference of scores, which equated to preoperative scores minus postoperative score, between Group A and Group B were also prominent (P < 0.01). Post-operation ascending venography was performed on 67 limbs in Group A. The effective rate of the operation is 83.58% (28 + 28/67), obviously effective rate is 41.79% (28/67). Same exam was performed on 12 limbs in Group B and the effective rate of the operation is 33.33%. The difference between two groups' effective rate is significant (P < 0.05). Clinical scoring of Group A decreased much more than Group B; The effective rate of Group A in ascending venography is also much higher than Group B. Encircling constriction of superficial femoral vein is useful to relief the symptom and recover the shape and function of the valve of superficial femoral veins. Those who are diagnosed to be PDVI by means of pre-operation ascending venography and Valsalva test should accept the operation of the encircling constriction of superficial femoral vein.

Deep venous thrombosis after radiofrequency ablation of greater saphenous vein: A word of caution

Purpose Radiofrequency ablation (RFA) of the greater saphenous vein (GSV; “closure”) is a relatively new option for treatment of venous reflux. However, our initial enthusiasm for this minimally invasive technique has been tempered by our preliminary experience with its potentially lethal complication, deep venous thrombosis (DVT). Methods Seventy-three lower extremities were treated in 66 patients with GSV reflux, between April 2003 and February 2004. There were 48 (73%) female patients and 18 (27%) male patients, with ages ranging from 26 to 88 years (mean, 62 ± 14 years). RFA was combined with stab avulsion of varicosities in 55 (75%) patients and subfascial ligation of perforator veins in 6 (8%) patients. An ATL HDI 5000 scanner with linear 7-4 MHz probe and the SonoCT feature was used for GSV mapping and procedure guidance in all procedures. GSV diameter determined the size of the RFA catheter used. Veins less than 8 mm in diameter were treated with a 6F catheter (n = 54); an 8F catheter was used for veins greater than 8 mm in diameter (n = 19). The GSV was cannulated at the knee level. The tip of the catheter was positioned within 1 cm of the origin of the inferior epigastric vein (first GSV tributary). All procedures were carried out according to manufacturer guidelines. Results All patients underwent venous duplex ultrasound scanning 2 to 30 days (mean, 10 ± 6 days) after the procedure. The duplex scans documented occlusion of the GSV in 70 limbs (96%). In addition, DVT was found in 12 limbs (16%). Eleven patients (92%) had an extension of the occlusive clot filling the treated proximal GSV segment, with a floating tail beyond the patent inferior epigastric vein into the common femoral vein. Another patient developed acute occlusive clots in the calf muscle (gastrocnemius) veins. Eight patients were readmitted and received anticoagulation therapy. Four patients were treated with enoxaparin on an ambulatory basis. None of these patients had pulmonary embolism. Initially 3 patients with floating common femoral vein clots underwent inferior vena cava filter placement. Of the 19 limbs treated with the 8F RFA catheter, GSV clot extension developed in 5 (26%), compared with 7 of 54 (13%) limbs treated with the 6F RFA catheter ( P = .3). No difference was found between the occurrence of DVT in patients who underwent the combined procedure (RFA and varicose vein excision) compared with patients who underwent GSV RFA alone ( P = .7). No statistically significant differences were found in age or gender of patients with or without postoperative DVT ( P = NS). Conclusion Patients who underwent combined GSV RFA and varicose vein excision did not demonstrate a higher occurrence of postoperative DVT compared with patients who underwent RFA alone. Early postoperative duplex scans are essential, and should be mandatory in all patients undergoing RFA of the GSV.