Clinical outcomes of nonthermal ablation, thermal ablation, and surgical stripping for varicose veins

ObjectiveThe purpose of this study was to compare the clinical outcomes of radiofrequency ablation (RFA), cyanoacrylate closure (CAC), mechanochemical ablation (MOCA), and surgical stripping (SS) for incompetent saphenous veins; to determine a suitable treatment modality in a specific clinical situation.MethodsWe retrospectively reviewed the data of patients with varicose veins who underwent RFA, CAC, MOCA, or SS from January 2012 to June 2023. Clinical outcomes, including postoperative complications and the Aberdeen Varicose Vein Questionnaire (AVVQ) score, were assessed.ResultsDuring the study period, 2,866 patients with varicose veins were treated. Among them, 1,670 patients (57.9%) were women. The mean age was 55.3±12.9 years. RFA, CAC, MOCA, and SS were performed in 1,984 (68.7%), 732 (25.4%), 78 (2.7%), and 88 (3.0%) patients, respectively. Complete target vein closures after RFA, CAC, and MOCA were 94.5%, 98%, and 98%, respectively. The absence of a target vein after SS was 98%. DVT developed in 4 patients; 1 in RFA group and 3 in CAC group. Surgical or endovenous procedure-induced thrombosis occurred in 2.3%, 4.8%, 6.4%, and 2.3% of patients after RFA, CAC, MOCA, and SS, respectively. Phlebitis along the target vein occurred in 0.2% and 3.8% of patients after RFA and MOCA, respectively. Hypersensitivity reaction occurred in 3.7% of patients after CAC. Readmission was required in two patients who had undergone the SS procedure. Transient nerve symptoms developed in 5 (0.3%), 0, 1 (1.3%), and 2 (2.3%) patients after RFA, CAC, MOCA, and SS, respectively. After treatment, the AVVQ score improved significantly in all groups.ConclusionsClinical outcomes with improvement in quality of life were comparable among the different treatment modalities. The proximity of the nerve or skin to the target vein is the most important factor in selecting a suitable treatment modality.