Interesting Scenarios during Radiofrequency Ablation of Varicose Veins at University Hospital of Nepal

Table 1

Possible interesting scenarios during RFA of varicose veins.

S.N.	Interesting scenarios	Definition
1	Double GSV	If two GSVs have a similar diameter draining a common cutaneous territory and opening directly into the saphenofemoral junction, it is commonly termed as a double great saphenous vein [6]. In double GSV, two GSVs course within the saphenous compartment and are connected by the saphenous ligament [7] (Figure 1)
2	“Shy GSV phenomenon”	There is no such terminology we could find even after an extensive literature search. However, in some cases, we have found that great saphenous veins tend to go into spasm after puncturing with a cannulation needle during RFA. Even while trying proximal cannulation, the spasm reoccurs in some cases making percutaneous cannulation impossible. We are using the term “shy GSV phenomenon” for this phenomenon
3	Recurrence due to a lymph node vessel	This is the vessel located in the lymph nodes in Scarpa’s triangle between the anterior accessory saphenous vein and great saphenous vein, which has a size of 1-3 mm in diameter and is tortuous in nature [8]. These veins directly drain into the deep venous system and can be a reason for recurrence of varicose veins in some cases [8, 9]
4	Tortuous or angulated great saphenous vein leading to a double-puncture technique	Tortuosity of veins below the knee and above the knee and angulation of veins at the level of the distal thigh
5	GSV and deep system too close	We like to highlight this scenario and have termed GSV close to the deep system if distance is less than 1 cm. The significance of this is that during RFA, it can cause injury to deep veins and cause DVT.