Recurrent Great Saphenous Vein Reflux After Prior Endovenous Laser Therapy: Diagnostic and Management Challenges in Chronic Venous Insufficiency.

The comorbidity of chronic venous insufficiency is a prevalent vascular disorder that has further risks of progressing to ulceration and recurrent symptoms despite prior intervention. Endovenous laser therapy (EVLT) has become a first-line treatment for chronic venous insufficiency, especially in the axial great saphenous vein (GSV) reflux due to its high technical success and favorable safety profile. However, the recurrence of venous reflux remains clinically significant and often requires repeat imaging and intervention to further manage the condition. We present the case of a 54-year-old female patient with a history of chronic deep vein thromboses and prior EVLT of the right GSV who developed recurrent axial reflux associated with lateral malleolar ulceration. With duplex ultrasound mapping, we were able to demonstrate near-continuous reflux in the proximal GSV with incompetent accessory and perforator veins. Overall, this case report highlights the importance of comprehensive venous duplex imaging in identifying the mechanisms of recurrence and guiding management decisions, including the consideration of cyanoacrylate closure versus repeat thermal ablation.