Objective: Primary varicose veins below the knee were managed with the assistance of endoscopic surgery in 240 limbs (235 cases). Methods: Patients were classified into five clinico-anatomic types according to associated normal veins involved in the varicosities. All procedures were limited to below the knee. With the superior illumination and magnified monitor view offered by the endoscope, all the varicosities and the incompetent perforating veins were dissected, clipped, divided and removed through one or more access incisions (2.5–3.0 cm in length). However, the normal veins were preserved, including the long saphenous vein. Results: The mean number of incisions in each limb of all patients was 1.86. As there were no residual varicosities or incompetent perforating veins, there was little possibility of recurrence. In the follow-up of 218 limbs, recurrence occurred in only two limbs. Conclusion: Endoscope-assisted surgery is a good alternative for management of primary varicose veins below the knee, resulting in low recurrence and aesthetically acceptable surgical scarring.
