SP4.05 Beyond the Scalpel: Evaluating Endovenous Ablation Techniques for Varicose Vein

Abstract Aims Varicose veins affect 17% of females and 15% of males globally, significantly impairing quality of life. Endovenous ablation techniques, including thermal methods such as Endovenous Laser Ablation (EVLA) and Radiofrequency Ablation (RFA), as well as non-thermal approaches like Mechanochemical Ablation (MOCA) and cyanoacrylate adhesive, offer minimally invasive alternatives to traditional surgery. This study aimed to evaluate the efficacy, safety, and patient-reported outcomes of these interventions. Methods We conducted a systematic search that identified 35 studies with more than 6,500 patients. Primary outcomes included occlusion and recurrence rates. Secondary outcomes included patient-reported improvements using the Aberdeen Varicose Vein Questionnaire (AVVQ) and Venous Clinical Severity Score (VCSS) and adverse events. The analysis followed PRISMA guidelines with a random-effects model used for the data synthesis. Results EVLA and RFA achieved high occlusion rates of 94.9% and 94.4%, respectively, comparable to surgical stripping at 92.0%. Slightly lower rates were observed for non-thermal methods at 88.7%, but these reduced post-procedural pain (MOCA: 1.2/10 vs EVLA: 3.8/10). Average recurrences were similar across methods at 6.2%. Improvements in AVVQ scores by 7.8 points and VCSS scores by 3.5 points reflect a quality-of-life gain. Adverse events such as superficial thrombophlebitis and skin burns were more common following thermal methods (6.8%) than non-thermal approaches (2.5%). Conclusion Endovenous ablation techniques are valid and safe alternatives to surgery, showing high success rates with significant quality-of-life improvements. Non-thermal procedures offer less complications and less post-operative pain, making them attractive options. Long-term studies are warranted to confirm the durability of these techniques.