Thermal versus nonthermal ablation for treatment of great saphenous veins in patients with lower extremity superficial venous disease.

backgroundChronic venous disease is a prevalent condition that significantly impacts the quality of life of affected patients. In the last 20 years, minimally invasive treatments have become widespread and have typically been classified into thermal or nonthermal ablative techniques. However, few studies have evaluated the efficacy of these interventions, with limited comparative data available with respect to quality of life.

methodsThis was a retrospective cohort study of adults undergoing thermal or nonthermal ablation of unilateral, great saphenous vein (GSV)-truncal veins, identified from the Vascular Quality Initiative Varicose Vein Registry, from 2014 to 2026. Patients with nontruncal, bilateral, or non-GSV-treated veins were excluded. The primary outcome of interest and comparator was long-term quality-of-life outcomes. Fisher exact and Mann-Whitney tests were used to compare categorical and continuous variables.

resultsA total of 23,247 patients were analyzed. Ultimately, 14,277 patients undergoing 17,504 procedures met inclusion criteria, with 39% (n = 8970) of patients failing to meet criteria because of missing procedural data regarding ablation technique, laterality, or truncal vein status. Eighty-three percent of procedures were thermal ablations (n = 14,481) compared with 3023 (17%) nonthermal ablations. Nonthermal ablation patients tended to be older (61 [48-70 years vs 58 [46-68] years; P < .0001) and white (85% vs 79%; P < .0001). A higher proportion of thermal ablations occurred in hospitals (34% vs 28%; P < .0001) compared with ambulatory/office-based settings. Furthermore, thermal ablation patients differed from nonthermal ablation patients with respect to prophylactic procedural anticoagulation utilization (low-molecular-weight heparin: 9% vs 6%; P < .0001 and unfractionated heparin: 3% vs 1%; P < .0001) and rates of multiple anesthetic modalities (55% vs 17%; P < .0001) and regional/tumescent (35% vs 4%; P < .0001) utilization. Thermal patients were more likely to have above-knee GSV (89% vs 78%; P < .0001) and a larger diameter vein (7.3 [6.0-9.1] vs 6.0 [4.0-8.0] mm; P < .0001) treated. Patients in the nonthermal group had lower rates of paresthesia in the treated extremity (3% vs 1%; P = .0003) and were more likely to have improvements in Clinical, Etiology, Anatomy, and Pathophysiology scores from C3 to C1 or C3 to C0 (8% vs 6%; P < .0001). Nonthermal patients were also more likely to have pain improvements from severe to mild/moderate (3% vs 2%; P = .0008).

conclusionsThermal and nonthermal ablations were both associated with clinical improvement in chronic venous disease. However, patients treated with nonthermal ablations demonstrated greater improvement in Clinical, Etiology, Anatomy, and Pathophysiology class and pain improvement from severe to mild or moderate. These findings suggest a potential therapeutic advantage in symptom resolution and functional recovery with nonthermal ablative techniques. Further investigation regarding long-term quality-of-life measures following nonthermal ablation is warranted.