Early Morphological Changes in Superficial Varicose Veins After Endovenous Radiofrequency Ablation

To quantify early changes in untreated varicose tributaries and treated saphenous veins after isolated radiofrequency ablation (RFA) and to assess 3-month technical outcomes.

This retrospective cohort included 133 patients undergoing RFA of the great saphenous vein (GSV; n=120) or small saphenous vein (SSV; n=13). The primary outcome was within-patient change in the largest untreated varicose tributary diameter from baseline to approximately 3 months. The same radiologist reassessed the anatomically documented site. We used paired analyses, bootstrap confidence intervals, and multivariable analysis of covariance with robust standard errors.

Median tributary diameter decreased from 14.2 mm (IQR, 10.5-21.0) to 11.0 mm (IQR, 7.4-14.2). The median within-patient reduction was 3.0 mm (IQR, 0.9-5.8; 95% bootstrap CI, 2.2-3.7; p<0.001). Completion DUS confirmed closure of the proximal treated saphenous segment and patency of the adjacent deep vein in all patients. At approximately 3 months, complete occlusion was present in 99 of 120 GSVs (82.5%) and all 13 SSVs. The remaining 21 GSVs had short-segment partial recanalization with residual reflux near the saphenofemoral junction; none had complete recanalization. In an exploratory adjusted analysis, diabetes mellitus was associated with a 1.15-mm larger 3-month GSV diameter (95% CI, 0.23-2.07; p=0.015).

Isolated RFA was associated with an early reduction in untreated varicose tributary diameter. These anatomical findings suggest that reassessment before adjunctive tributary treatment may be reasonable; however, clinical benefit cannot be inferred without patient-reported outcomes. The association between diabetes and 3-month GSV diameter is hypothesis-generating.