Clinical Outcomes and Feasibility of Nonthermal, Nontumescent Ablation for Isolated Below-the-Knee Great Saphenous Vein Incompetence.

OBJECTIVE: To assess feasibility, clinical outcomes, and safety of nonthermal, nontumescent (NTNT) ablation for symptomatic isolated below-the-knee (BTK) great saphenous vein (GSV) incompetence with competent saphenofemoral junction and above-knee GSV. METHODS: This multicenter retrospective study included 73 treated BTK-GSV limbs in 50 patients who underwent NTNT ablation (mechanochemical ablation [MOCA] or cyanoacrylate adhesive closure [CAC]) between October 2020 and April 2025. Isolated BTK-GSV incompetence was defined as reflux ≥1.0 second confined to the BTK segment on duplex mapping without junctional or above-knee truncal reflux. Follow-up duplex ultrasound and Venous Clinical Severity Score (VCSS) assessments were performed at 1 week and 1, 3, 6, and 12 months. RESULTS: Immediate post-procedural duplex ultrasound confirmed complete occlusion of the treated BTK-GSV segment in all limbs. No partial or complete recanalization was observed during follow-up. The median VCSS improved significantly from 4 [interquartile range (IQR), 3-4] at baseline (n=73) to 0 [0-1] at 1 week (n=51), 0 [0-1] at 1 month (n=73), 0 [0-1] at 3 months (n=73), 0 [0-0] at 6 months (n=73), and 0 [0-0] at 12 months (n=43) (all P < .001 vs baseline, Wilcoxon signed-rank test). No major adverse events occurred, including deep vein thrombosis, pulmonary embolism, or permanent paresthesia suggestive of saphenous nerve injury. Minor events included superficial phlebitis (8%), ecchymosis (7%), and skin rash related to bandages or compression stockings (7%), all resolving with conservative management. CONCLUSIONS: NTNT ablation appears to be a safe and effective option for symptomatic isolated BTK-GSV reflux, providing significant clinical improvement with durable occlusion and without thermal-related nerve injury.