Comparison of long-term outcomes and quality of life following radiofrequency ablation, endovenous laser ablation, and N-butyl cyanoacrylate treatment of greater saphenous vein insufficiency

Abstract

Objective

To compare the long-term clinical outcomes and quality of life after radiofrequency ablation (RFA), endovenous laser ablation (EVLA), and N-butyl cyanoacrylate (NBCA) treatments in patients with chronic venous insufficiency.

Methods

This retrospective study included 600 patients treated with RFA, EVLA, or NBCA for chronic venous insufficiency at a single center between February 2015 and February 2025. Patients were divided into 3 groups of 200 according to the treatment modality. Clinical and procedural parameters, complication rates, pain scores, time to return to daily activities, Venous Clinical Severity Scores (VCSS), and great saphenous vein (GSV) occlusion rates were compared among groups.

Results

Statistically significant differences were found among the groups regarding complication rates, pain scores at 6 hours, procedure duration, time to return to daily activities, long-term GSV occlusion, and 5-year VCSS values (all P < .05). Complication-free rates were highest in the RFA group (89.5%), followed by NBCA (86.0%), and were lowest in the EVLA group (69.0%) (P < .001). EVLA had more frequent pigmentation, paresthesia, and phlebitis. NBCA had the shortest procedure time (13.7 minutes) and the greatest postprocedural pain and delayed return to daily activities. At 5 years, RFA showed the highest GSV occlusion rate (88.4%), whereas NBCA and EVLA had lower rates (70.6% and 75.0%, respectively) (P < .001). VCSS values at 5 years were more favorable in the RFA and NBCA groups compared with the EVLA group (P = .036).

Conclusions

All three endovenous techniques are effective and safe for the treatment of GSV insufficiency. However, the choice of modality should consider differences in complication rates, patient comfort, and long-term vein occlusion outcomes.