Ultrasound-Guided Extraluminal Venous Valve Functional Remodeling

BACKGROUND: Endovenous treatment for varicose veins is predominantly ablative, whereas vein-preserving approaches remain limited. CASE SUMMARY: A 60-year-old man with left lower extremity varicose veins and pruritus underwent ultrasound-guided extraluminal circumferential hyaluronic acid injection around the incompetent terminal valve at the left saphenofemoral junction after duplex ultrasound confirmed primary superficial venous valve incompetence. Immediate and early follow-up duplex ultrasound showed abolition of reflux, with brief reflux <0.5 seconds at 3 months and recurrent reflux >0.5 seconds at 12 months. No procedure-related complications occurred. DISCUSSION: This case documents immediate and stage-dependent changes in venous valve behavior after a vein-preserving extraluminal intervention and highlights the role of duplex ultrasound in guidance and serial assessment. TAKE-HOME MESSAGES: Extraluminal intervention may induce short-term changes in reflux without vein ablation. Durability and clinical significance require further study. (Feasibility Study of Ultrasound-guided Functional Remodeling of Lower Extremity Superficial Venous Valve; NCT05914740).