Radiofrequency vs mechanochemical ablation for small saphenous vein insufficiency

Background: Radiofrequency ablation (RFA) and mechanochemical ablation (MOCA) have emerged as less invasive alternatives to traditional surgical interventions, offering reduced recovery times and comparable efficacy. This study aims to compare the efficacy, safety, and patient-reported outcomes between RFA and MOCA in treating SSV insufficiency. Materials and methods: this is a retrospective, nonrandomized study that involved patients who underwent either RFA or MOCA between 2015 to 2019. Data collected included demographics, clinical grading, procedural specifics, and follow-up outcomes. The primary endpoint was the comparison of freedom from recanalization and freedom from reinterventions rates, while secondary endpoints focused on recurrences rates and clinical outcomes assessed by revised clinical severity score (rVCSS), and Aberdeen Varicose Vein Questionnaire (AVVQ). Results: A total of 132 limbs were treated (n=72 RFA; n=60 MOCA). Baseline demographics and clinical severity were comparable between groups. At 5 years, freedom from recanalization rate was significantly higher in the RFA group compared to the MOCA group (91.7% vs 66%; p=.0014). Clinical recurrence rates at 5 years were 11.7% for RFA and 22% for MOCA (p=.0023), while freedom from reintervention rates were 93.3% and 72.7%, respectively (p=.0011). Although both groups showed clinical improvement over time, patients treated with MOCA exhibited a significant worsening in rVCSS and AVVQ at 3 and 5 years compared to the RFA group (p<.0001). Conclusions: RFA demonstrates greater long-term stability, lower recurrence and reintervention rates compared to MOCA, suggesting it may be a preferable option for SSV insufficiency treatment in terms of durability and patient outcome.