Society for Vascular Surgery Vascular Quality Initiatives Contemporary Benchmarks: Varicose Vein Treatments

Venous ablation is the main procedural treatment of patients with varicose veins. This study provides benchmark outcomes and utilization trends for thermal and non-thermal ablations for patients with varicose veins undergoing initial treatment in the vascular quality initiative (VQI) registry.

The VQI Varicose Veins registry was queried for patients treated between 2014 and 2025 at a truncal vein with no prior varicose venous treatment. Patients were stratified by index intervention into thermal or non-thermal ablation groups. Primary outcomes included improvement in Venous Clinical Severity Score (VCSS) and Patient-Reported Outcomes (PRO) assessed by HASTI (Heaviness, Achiness, Swelling, Throbbing, Itching).

Among 44,883 patients undergoing 71,889 procedures, 38,978 (86.8%) were treated with ablation as the primary procedure. Thermal ablation declined from 91.5% to 53.0% of procedures (P<0.001), while non-thermal ablation increased from 0% to 30.9% (P<0.001) over the duration of the study. Ligation and stripping increased in the registry but remained low (0% to 2.3%, P<0.001). After exclusions, 23,598 patients undergoing initial truncal vein ablation were analyzed, including 21,920 (92.9%) thermal and 1,678 (7.1%) non-thermal ablation. Patients undergoing thermal ablation were younger, had lower BMI, had fewer prior DVTs, were less likely to receive pre/perioperative anticoagulation, and more often had deep venous reflux. Patients treated with non-thermal ablations were more likely to be male and had more baseline ulceration but lower baseline HASTI scores, underwent fewer concomitant procedures, and more frequently underwent treatment of truncal veins other than the GSV. Thermal ablation had fewer systemic complications (0.3% vs 0.7%, P=0.007), while local complication rates were similar between groups. Thermal ablation produced greater mean improvements in VCSS (-4.3 vs -3.2, P<0.001) and HASTI (-6.9 vs -3.8, P<0.001) post-treatment. Additionally, a higher proportion of patients treated with thermal ablation reported improvement in VCSS (83.9% vs 74.6%, P<0.001) and HASTI (86.3% vs 71.3%, P<0.001).

Venous ablations improve symptoms of venous insufficiency in the majority of patients treated as measured by clinical severity scores and patient reported outcomes. Complications are minor and infrequent regardless of the ablation modality.