Locally painful, recurrent, left medial thigh varicosities in 56-year-old G3P3 female 21 years after great saphenous stripping. She has no pelvic symptoms. Ultrasound examination (not shown) demonstrates reflux in the bilateral ovarian and left internal iliac veins associated with pelvic varices communicating with the extrapelvic varices over the left medial thigh. No right internal iliac or superficial or deep lower extremity reflux is seen on ultrasound. Venography demonstrates pelvic origin varices over the medial thigh communicating with pudendal (black arrow) and inguinal (red arrow) tributaries of the left internal iliac vein. The Symptoms-Varices-Pathophysiology (SVP) classification is S3bV2,3b. PBGV,R,NT; LIIV,R,NT; LPELV,R,NT ; Left C2s,rEpAs,dP(r) IIV,Pelvic,NSV.