First, identify where reflux starts.
Assessment goes beyond visible bulging veins. Duplex ultrasound helps establish the direction of flow, the extent of reflux and anatomical relationships, which the clinician then relates to your symptoms.
The UFLA case illustrates this distinction. The great and small saphenous veins were competent, while reflux originated from a deep muscle branch. Normal trunks do not rule out branch disease; equally, a normal branch should not be treated simply because it is visible.
Below-knee reflux is not the same as recurrence.
If reflux extends below the knee, treating only the above-knee segment may leave persistent reflux distally. This is a blood-flow finding; it cannot be interpreted directly as the overall rate of clinical varicose-vein recurrence.
The decision to treat below the knee depends on symptoms, reflux extent, vein depth, adjacent tissues and overall health. Assessment determines the treatment extent for each patient.
Each study addresses a specific question.
SPOT explores intermittent point-by-point ablation of the below-knee great saphenous vein. UFLA explores sheathless access to a short deep muscle branch. They are distinct approaches with separate outcomes and research populations.
Source: Yang CC. JVS–CIT. 2026;102274. Case report, Discussion Original article
Source: Yang CC. JVS–CIT. 2026;102468. Introduction, Limitations Original article