Consider the structures beside the vein.
In the distal calf, the saphenous nerve may lie very close to the great saphenous vein, with individual variation. Planning thermal ablation involves considering heat exposure to nearby nerves as well as closure of the target vein.
Why do ultrasound and tumescence matter?
Ultrasound helps locate the vein and fiber tip. Perivenous tumescent fluid provides local anesthesia, tissue separation and a heat sink. Both papers stress that treatment should not proceed when the fiber tip cannot be clearly identified.
These measures have protective aims, but taking precautions does not make injury impossible.
SPOT pauses are a strategy under investigation.
SPOT uses a brief pulse, withdrawal and ultrasound reconfirmation before the next point. Pauses are intended to permit partial cooling. Tissue temperatures were not measured and the effects of individual protective measures were not isolated, so the proposed mechanism remains unconfirmed.
Why does 0/19 not mean zero risk?
At one month, no paresthesia was reported in 19 limbs; the reported 95% confidence interval was 0%–17.6%. Assessment relied on symptoms, without nerve conduction studies or routine sensory testing of asymptomatic limbs. Subclinical changes cannot be excluded.
If you experience tingling, altered sensation or reduced sensation, describe its location and progression at review so the clinician can assess it.
Source: Yang CC. JVS–CIT. 2026;102468. Technique, Outcome assessment, Limitations Original article
Source: Yang CC. JVS–CIT. 2026;102274. Limitations Original article