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

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.