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OPEN ACCESS The classical surgical treatment methods of chronic venous insuf iciency (CVI) are high ligation (HL) and stripping of the saphenous varicose veins, and percutaneous phlebectomy [1,2]. Both the classical methods and the newer ones directed to relieve the cause (re lux) and result (varicose veins). The prevention of the recurrence necessiates the treatment of re lux before the varicosities [3,4]. Although the elimination of re lux is poossible with surgery, the new ablation techniques such as endovenous laser ablation therapy (EVLT), radiofrequency (RF) and foam ablation come into currency more and more with their advantage of being performed with only local anesthesia. However, these techniques, still have the potential for residual saphenofemoral re lux due to incomplete ablation of all side branches of the saphenofemoral junction (SFJ) [3,4]. All newer thermal ablation techniques cannot obliterate completely the side branches draining to the SFJ which is possible with HL and surgery. Although the classical surgical HL has also been blamed to lead to recurrent varicose vein development due to neovascularization, it is shown that real neovascularization demonstrated by Doppler is rare and is mostly related to the improper division of SFJ and side branches Therefore, the inadequate surgical technique is the main responsible factor and neovascularization is never the only cause of recurrence [5]. Neovascularisation has an incidence of 7.1% after EVLT and 2.2% after RF ablation also.. The responsible factors are the development of arteriovenous istulae and the intensity of the in lammatory response for recanalization of ablated venous segments [3-5]. The indings about the greater saphenous vein (GSV) recanalization at the SFJ have more commonly been found in patients undergoing RF ablation without ligation (46%) than RF ablation with ligation (14%) also support the importance of complete SFJ ligation [3-5]. It was found that surgery was not inferior to newer endovenous procedures.in comparison of recurrence rates, overall complication rates, and symptom relief. Our results of former studies comparing the three different surgical techniques (complete stripping with HL, partial above-knee stripping with HL, and HL alone) have clearly shown that the best recurrence rate, best improvement in CEAP class, and best event-free survival rates are achieved using complete stripping with HL [6,7]. The rate of residual re lux and recurrence after partial stripping can reach up to 20%,as more often with patent below-knee saphenous veins than with incompetent perforatory veins (IPVs) undetected preoperatively. If these newer techniques can be described as theoretically equivalent to stripping with low ligation of the proximal saphenous vein, it is not wise or completely true to claim that their recurrence rates and effectiveness are better than those of classical complete stripping with HL. Past experiments have shown that, HL with complete division of the SFJ and all side branches, full-length obliteration of the saphenous vein is the best treatment chocie to prevent recurrence [7].

Foam Sclerotherapy versus surgery in treatment of chronic venous disease