Comparison of high-frequency techniques in ablation of great saphenous vein for varicose vein treatment

Aim: To evaluate the outcomes of patients who underwent two different high-frequency techniques of varicose vein endovenous ablation in the great saphenous vein (GSV) region (radiofrequency ablation [RFA] or high-frequency endovenous welding [HFEW]), and to find out the options to improve long-term results.

Materials and Methods: The retrospective study enrolled 120 patients with primary varicose veins in the GSV region with CEAP stages C2-C6, treated in two private centers and operated on by a single operator from 2019 to 2021. The enrolled sample was subdivided into RFA (VNUS ClosureFast [n=58]) and HFEW ("SVARMED", Ukraine [n=62]) groups. Primary (such as occlusion rates) and secondary outcomes (such as postoperative pain [by VAS scale], complications, and recurrence rates) were assessed at 7 days, and at 3, 6, and 12 months postprocedurally.

Results: Both RFA and HFEW techniques showed high occlusion rates at 12 months postoperatively (96% and 97%, respectively [p=1,000]). The adverse events and perioperative complication rates were low and comparable between the two studied groups. Recurrence of varicose veins at the 12-month follow-up was numerically, but non-significantly, higher in the RFA group compared to HFEW (total: 14% vs. 6%, respectively [p=0,230]; junction source: 10% vs. 3%, respectively [p=0,154]).

Conclusions: Ablation of the GSV in patients with varicose vein disease by RFA and HFEW showed comparable early and midterm results with high occlusion rates at 12 months postoperatively. Recurrences in the RFA group, being numerically higher compared to the HFEW group, were primarily caused by new reflux coming from the femoral junction. HFEW requires further research for technical improvement and widespread implementation in practice.