Endovenous thermal ablation combined with foam sclerotherapy is a safe and effective method for the treatment of lower extremity varicose veins: a multicenter retrospective analysis

Abstract

To compare the safety, efficacy, and perioperative outcomes of radiofrequency ablation (RFA) and endovenous microwave ablation (EMA), each combined with foam sclerotherapy, versus traditional high ligation and stripping (HL/S) for symptomatic lower extremity varicose veins. The primary endpoint was the change in Venous Clinical Severity Score (VCSS) from baseline to 12 months postoperatively. This multicenter retrospective study analyzed 305 patients from two hospitals, divided into three groups: RFA + sclerotherapy ( n = 102), EMA + sclerotherapy ( n = 101), and HL/S ( n = 102). Perioperative outcomes (operation time, blood loss, hospital stay), postoperative pain (Visual Analog Scale, VAS), inflammatory markers (CRP, IL-6), dorsal foot venous pressure, coagulation parameters, complication rates, Venous Clinical Severity Score (VCSS), and Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ-20) scores were assessed and compared up to 12 months postoperatively. Both minimally invasive groups demonstrated superior perioperative outcomes compared to HL/S, including shorter operation times, less blood loss, and reduced hospital stays. Postoperative pain scores were significantly lower in the RFA and EMA groups, with RFA showing the lowest early pain levels. Inflammatory markers (CRP, IL-6) and coagulation activation (D-dimer, fibrinogen) were significantly lower in the ablation groups, with RFA values being the lowest. Complication rates were lower in the RFA (34.3%) and EMA (41.6%) groups versus HL/S (58.8%). However, no significant differences were observed among the three groups in long-term VCSS, CIVIQ-20 scores, or recurrence rates at 12 months. RFA and EMA combined with sclerotherapy are safe and effective minimally invasive alternatives to HL/S, offering advantages in faster recovery, less pain, reduced inflammatory response, and fewer complications. While perioperative benefits favor thermal ablation, all three techniques provide comparable long-term symptomatic relief and quality-of-life improvement.