If an incompetent short saphenous vein is overlooked during an operation, varicosities invariably recur. A flush saphenopopliteal venous ligation is essential, since it is difficult to eliminate marked valvular insufficiency at this site by injections of a sclerosing solution. The prone position affords excellent exposure of the saphenopopliteal junction. Since the anatomy varies greatly, a flexible approach is desirable. If the anatomy is straightforward and the junction is close to the popliteal space, a transverse skin incision affords excellent exposure and heals well. Although it does not heal as well, a vertical or S-shaped incision is advisable in more complicated instances because it provides better exposure. If all valvular insufficiency is corrected at operation and the patient checked annually so that any new varices can be eliminated by injections, the leg should remain free of varicose veins.