Safety and efficacy of flush endovenous ablation of the great saphenous vein: A retrospective study

<b>Aim:</b> To assess the safety and efficacy of endovenous ablation of great saphenous varicose veins with flush ablation at the saphenofemoral junction.<b>Methods:</b> A retrospective study was conducted on consecutive patients with varicose veins related to the great saphenous vein (GSV) and undergoing endovenous thermal ablation between January 2020 and July 2024. All patients underwent either endovenous laser or microwave ablation. Primary endpoints included technical success and absence of endothermal heat-induced thrombosis (EHIT) ≥ 2. Secondary endpoints included deep vein thrombosis (DVT), pulmonary embolism (PE), recurrence, days to return to normal daily activity, and reintervention. Follow-up was performed at 1 week, 6 months, and annually thereafter. Technical success was defined as successful flush catheter placement at the SFJ under duplex guidance. Recurrence was assessed through clinical examination and duplex ultrasound.<b>Results:</b> 69 patients (79 limbs) were included with a mean age of 39.1 ± 12.5 y, and 30 were of male sex (43.5%). Technical success was achieved in all limbs. EHIT ≥2 was not documented at the first postoperative outpatient visit, and no DVT or PE were noted during follow-up (20.4 ± 11 months). Recurrence was documented in 2 limbs (2.5%). One limb required surgical reintervention, and the days to return to daily activity recorded a median of 15 days (IQR 10 - 30).<b>Conclusion:</b> Flush endovenous ablation may be a safe and effective technique for treating great saphenous varicose veins, demonstrating a low incidence of recurrence and deep vein thrombosis while maintaining high technical and clinical success rates. Our findings contribute to the growing body of evidence supporting flush ablation strategies and highlight the need for further research to optimise procedural guidelines.