Efficacy and safety of radiofrequency ablation combined with high ligation vs simple radiofrequency ablation for lower extremity varicose veins: a retrospective comparative study.

Abstract

Introduction: Simple radiofrequency ablation (RFA) is a standard minimally-invasive treatment for lower extremity varicose veins (LEVV), yet concerns regarding recurrence and efficacy in severe cases persist.

Aim: We aimed to evaluate clinical efficacy, safety, and long-term prognosis of RFA combined with high ligation (RFHL) vs simple RFA.

Materials and methods: This retrospective study analyzed 108 LEVV patients (from January 2020 to November 2024) divided into 2 groups based on the procedure they underwent: RFHL (n = 54) and RFA (n = 54). The comparisons included perioperative indicators, clinical efficacy, complications, and 1-year recurrence rates. A stratified analysis was performed for severe cases (Clinical-Etiology-Anatomy-Pathophysiology [CEAP] classification, C4-C6).

Results: Perioperative metrics (operative time, blood loss, recovery, and pain intensity) showed no differences between the groups. However, RFHL achieved a significantly higher total effective rate than RFA. Notably, in severe cases (C4-C6), RFHL efficacy was superior. The RFHL group demonstrated markedly lower complication and 1-year recurrence rates. Additionally, 6-month venous function was considerably better in the RFHL group.

Conclusions: RFHL is associated with comparable perioperative recovery to RFA but offers significantly higher efficacy, better safety, and lower long-term recurrence, especially in severe LEVV (CEAP, C4-C6). RFHL should be considered the preferred surgical approach for severe cases.