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. (J Vasc Surg Cases 2016;2:181-3.)