Endovenous Microwave Ablation Alone Versus High Ligation Combined With Microwave Ablation for Great Saphenous Vein Incompetence: A Propensity Score-Matched Study.

OBJECTIVES: To evaluate the clinical efficacy, perioperative outcomes, and direct healthcare costs of isolated endovenous microwave ablation (EMA) versus high ligation combined with EMA (HL+EMA) for great saphenous vein (GSV) incompetence. METHODS: A retrospective cohort study analyzed 205 patients (isolated EMA: n=104; HL+EMA: n=101), comprising 86 (42.0%) males and 119 (58.0%) females, treated for primary varicose veins (CEAP class C3-C4b) between Jan. 2022 and Dec. 2024. To mitigate selection bias, propensity score matching (PSM) was executed utilizing eight baseline covariates, including preoperative Venous Clinical Severity Score (VCSS) and Aberdeen Varicose Vein Questionnaire (AVVQ) scores. Nearest-neighbor matching yielded 73 adequately balanced pairs. Primary outcomes were the 12-month VCSS and AVVQ scores. Secondary endpoints included complications, length of stay, early pain scores, and hospitalization costs. RESULTS: At 12 months, both cohorts demonstrated highly significant improvements from baseline; however, no statistically significant between-group differences were detected in VCSS (1.47 ± 0.87 vs. 1.42 ± 1.05, P = 0.805) or AVVQ scores (7.90 ± 3.42 vs. 7.55 ± 2.69, P = 0.460). Overall 30-day complication rates were similar between groups (45.2% vs. 42.5%, P = 0.860). Conversely, the isolated EMA cohort was associated with a significantly abbreviated length of stay (median 2 vs. 6 days, P < 0.001), diminished 12-hour pain scores (median 2 vs. 4, P < 0.001), and a profound reduction in total hospitalization costs (median ¥14,099 vs. ¥17,306, P < 0.001). CONCLUSIONS: No statistically significant difference in 12-month functional outcomes was detected between isolated EMA and HL+EMA in this propensity score-matched cohort. Isolated EMA was associated with substantially reduced perioperative morbidity and lower direct hospitalization costs. Based on these intermediate-term findings, the routine addition of high ligation did not confer a detectable clinical advantage for CEAP C3-C4b GSV incompetence; however, longer-term follow-up is warranted.