Comparison of the safety and efficacy between endovenous laser ablation and radiofrequency ablation for great saphenous vein incompetence

Aims This multicenter retrospective study sought to compare the efficacy and safety of endovenous laser ablation (EVLA) versus radiofrequency ablation (RFA) for treating great saphenous vein (GSV) incompetence. Methods We performed propensity score matching (PSM) between 864 EVLA and 1009 RFA cases. Primary endpoints comprised complete venous ablation (efficacy) and incidence of deep vein thrombosis (DVT) and endovenous heat-induced thrombosis (EHIT) (safety). Secondary outcomes assessed at serial follow-ups included: Numerical Rating Scale (NRS) pain scores, cutaneous adverse events, Venous Clinical Severity Score (VCSS), and Chronic Venous Insufficiency Questionnaire (CIVIQ-20). Results The propensity-matched cohort ( n = 855 per group) showed balanced baseline characteristics after exclusions (all p > .05). Primary efficacy analysis revealed significantly lower 24-month recurrence rates with EVLA versus RFA (5.6% vs 10.2%, p < .001). Primary safety outcomes demonstrated reduced thrombotic complications with RFA, including lower DVT incidence (0.7% vs 1.8%, p = .048) and decreased EHIT formation (Class 0: 93.9% vs 89.7%; grades 1-4: 6.1% vs 10.3%, p = .034). Secondary analysis showed RFA’s advantages in pain profiles ( p < .001), cutaneous complications (skin burns: 2.7% vs 4.7%, p = .029), and superior therapeutic improvement through 24 months (VCSS: 0.66 ± 0.15 vs 1.66 ± 0.55, p = .029; CIVIQ-20: 5.66 ± 1.10 vs 10.66 ± 2.69, p = .006). Conclusion RFA demonstrates superior perioperative safety profiles, symptom relief, and quality-of-life outcomes. However, its significantly higher long-term recurrence risk compared to EVLA necessitates risk-stratified treatment algorithms.