Background: Saphenous vein degeneration is associated with significant morphological changes. This study compares the clinical and morpho-anatomical characteristics between patients with aneurysmal and non-aneurysmal insufficient great saphenous vein (GSV). Methods: A retrospective observational analysis was conducted on 75 patients with chronic venous disease. Patients were divided into Group A (n=17, GSV diameter ≥1.2 cm) and Group B (n=58, GSV diameter 0.6-1.2 cm). Clinical data and morpho-anatomical features were assessed using ultrasonography and histopathological examination. Results: Group A had significantly larger GSV diameter (1.4 ± 0.2 cm vs. 0.7 ± 0.1 cm, p < 0.001) and wall thickness (0.4 ± 0.1 cm vs. 0.2 ± 0.1 cm, p < 0.001). Elastic fiber fragmentation was more severe in Group A (55% vs. 29%, p < 0.01). Group A also had a higher mean BMI (31.4 ± 4.5 kg/m² vs. 27.4 ± 4.0 kg/m², p = 0.007) and longer hospitalization (2.1 ± 0.6 days vs. 1.5 ± 0.6 days, p = 0.0023). Conclusions: Aneurysmal degeneration is linked to more severe clinical and morphoanatomical changes, indicating a need for closer monitoring and more aggressive treatment strategies.