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Veins can reoccur after venous procedures. The majority of recurrences were in association with perforating veins. New AAGSV and SSV insufficiency was responsible for 40% of those patients who developed recurrent venous disease. The use of standard protocols and routine US examinations may reduce the frequency of saphenous vein recanalization after thermal ablation. New insufficiency in the unablated GSV can be reduced by beginning thermal ablations at mid-calf.