Thermoablation using the hedgehog technique for complex recurrent venous reflux patterns

Neovascularization after vein stripping is well recognized as a contributory cause of varicose vein recurrence. Treatment is challenging because of segment tortuosity and fibrous web formation. Surgical re-exploration is practiced, but foam sclerotherapy is becoming preferred. We suggest an alternative method using thermoablation with a technique originally intended for treatment of perforator vein reflux. This modification has not been described in the context of recurrent neovascularization before. By ultrasound-directed insertion of multiple intravenous cannulas into convoluted neovascularized segments, recurrences in the groin, popliteal fossa, and truncal vein strip tracks can be successfully ablated by endovenous laser ablation