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ObjectivesChronic venous insufficiency (CVI) is a prevalent condition with significant socioeconomic implications. Endovenous radiofrequency ablation (RFA) is a minimally invasive treatment option that has gained widespread acceptance due to its high efficacy and low complication rates. This study aimed to investigate the effectiveness of a novel venous access technique using a subcutaneous side branch of the greater saphenous vein (GSV) and compare it to the conventional direct GSV access technique.MethodsA total of 211 patients (288 legs) with CVI were randomly assigned to either the conventional access group (group 1, 145 legs) or the subcutaneous side branch group (group 2, 143 legs). Patients were assessed for demographic characteristics, venous access success rates, complications, and clinical outcomes. The primary outcomes were venous access success and procedural time, while secondary outcomes included complication rates such as vasospasm, ecchymosis, and thrombophlebitis.ResultsThe mean access time was significantly lower in group 2 (30.8 ± 9.9 seconds) compared to group 1 (46.7 ± 14.9 s) (p < 0.001). Additionally, group 2 required fewer cannulation attempts (1.28 ± 0.5) than group 1 (2.2 ± 0.9) (p < 0.001). Vasospasm occurred less frequently in group 2 (3.1%) than in group 1 (5.2%) (p = 0.005), and group 2 had significantly lower rates of ecchymosis (p = 0.033), thrombophlebitis (p = 0.026), and paresthesia (p = 0.045). No significant differences were observed between the groups regarding thermal skin injury (p = 0.142) or GSV occlusion rates at 3 months.ConclusionsThis study demonstrates that accessing the GSV via a subcutaneous side branch is a feasible and advantageous technique, leading to faster cannulation and reduced complication rates compared to the conventional approach. Further research is warranted to assess this novel technique's long-term outcomes and potential benefits in diverse clinical settings.