I think it is a bit of both.. both the vein’s correct occlusion and patient’s satisfaction are important and related to each other … long term satisfied patients come from correct treatment done..
I would prefer endovenous ablation of the GSV and SSV (with such large veins I would use a radial laser) and TRLOP of perforators – then 8 weeks or so later, foam sclerotherapy to sub-ulcer plexus. However, some might prefer the TIRS technique and use only foam – but such a large amount of reflux…
Good question – I would use a thermal ablation to close as many connections with the femoral vein as possible (TRLOP / Hedgehog) or even HIFU – then foam more superficially anything that is left.
Well, usually I use STS (Fibrovein) foam, but I believe Aethoxysklerol foam can be used as well but in higher concentrations (2 -3 %)..