Comparison of Radiofrequency Ablation and High Ligation Stripping for Varicose Veins: A Retrospective Analysis

To compare the clinical efficacy, postoperative complications, and quality-of-life (QoL) outcomes of ultrasound-guided radiofrequency ablation (RFA) combined with tributary phlebectomy and foam sclerotherapy versus high ligation and stripping (HLS) combined with tributary phlebectomy.

We retrospectively analyzed 2,740 patients (1,588 women; mean age 59.01 ± 12.03 years) treated between October 2020 and October 2023. Among them, 1,756 (64.1%) underwent RFA and 984 (35.9%) underwent HLS. We assessed immediate success rate, 12-month recanalization, symptomatic recurrence, reintervention rate, and complications; The Aberdeen varicose vein questionnaire (AVVQ) and chronic venous insufficiency quality of life questionnaire (CIVIQ-14) scores were used to evaluate QoL, while the venous clinical severity score (VCSS) was used to assess disease severity at 1, 6, and 12 months postoperatively.

Immediate success was achieved in both groups. At 12 months, the RFA group had 7 recanalizations (0.40%) versus 0 in the HLS group (P = 0.112); symptomatic recurrence was 0.17% versus 0.20% (P = 1.000); reintervention rate was 2.62% versus 3.05% (P = 0.064); and each group had 2 cases of deep vein thrombosis. Minor complications in the HLS group included bruising (25.20% vs. 20.16%, P = 0.002), pain (25.41% vs. 20.39%, P = 0.002), and numbness (10.98% vs. 3.30%, P < 0.001); the RFA group had higher induration (17.20% vs. 3.25%, P < 0.001) and pigmentation (2.62% vs. 0.81%, P = 0.001). Both groups showed significant improvements in AVVQ, VCSS, and CIVIQ-14 scores (P < 0.05), with the RFA group demonstrating greater early improvement at 1 month.

Ultrasound-guided RFA with foam sclerotherapy reduces minor complications such as pain, bruising, and numbness and significantly improves early QoL, though it carries a higher risk of induration and pigmentation. Both RFA and HLS offer good long-term efficacy and low recurrence rates; treatment should be individualized based on patient condition and recovery needs.