<b>Case Report Accessory Great Saphenous Vein</b> The anterior accessory great saphenous vein AASV is a common pathway for both primary and recurrent symptomatic varices, which is often inadequately recognized by those unfamiliar with venous anatomy. Varicose veins are a common disorder. Extensive ultrasound US mapping of lower extremity chronic venous valvular insufficiency includes the great saphenous vein GSV , anterior accessory saphenous vein AASV and thigh posterior tributary to GSV such as the posterior accessory saphenous vein PTSV, PASV 1 3 Anatomically, the AASV vessel rests within the same layer of the limb as the GSV, lying just superficial to the deep venous system over the proximal anterior thigh. It has been shown that both the refluxing GSV and AASV patterns adversely affect patient perceived quality of life measures.4,5 Despite the common finding of AASV reflux, the majority of governing bodies focus on few vein patterns, namely the great saphenous and small saphenous veins.6Conclusion Patterns of reflux from the saphenofemoral junction to either the anterior accessory saphenous vein or great saphenous vein possess similar disease severity and commonly suffer complications of venous stasis. The lateral accessory saphenous vein is the commonest cause of recurrence in the groin of varicose veins. It should be looked for specifically during pre operative assessment duplex scanning and at primary surgery. If identified at operation, we believe it should be either stripped or avulsed to reduce the risk of recurrence. The great saphenous vein GSV , Anterior accessory saphenous vein AASV posterior tributary saphenous vein, posterior accessory saphenous vein PTSV, PASV 1188-1190 Issue-6 Volume-2 Shobha. G | Uma. B. Gopal | Santoshkumar Singarapu | Akashata. B. K | Jeevankumar Giri | Manu Krishnan. K