Endovenous ablation of the great saphenous varicose veins: Does the modality matter? A prospective cohort study

Objective Endovenous thermoablation (EVTA) is considered the reference treatment for great saphenous vein (GSV) reflux. Catheter-directed foam sclerotherapy offers a simpler and potentially safer alternative without thermal injury or tumescent anesthesia. This study compared the anatomical durability, clinical outcomes, and safety of EVTA and catheter-directed foam sclerotherapy for treatment of GSV insufficiency. Methods A prospective comparative study was conducted at a single tertiary center between April 2021 and June 2024, including patients with duplex-confirmed GSV reflux (CEAP C2–C4). Patients underwent EVTA (radiofrequency or laser ablation) or catheter-directed foam sclerotherapy according to clinical preference and device availability. The primary endpoint was anatomical success defined as complete GSV occlusion at 1 year on duplex ultrasound. Secondary outcomes included changes in Venous Clinical Severity Score (VCSS), Venous Disability Score (VDS), Aberdeen Varicose Vein Questionnaire (AVVQ), perioperative outcomes, and complications. Kaplan–Meier analysis was used to compare occlusion durability. Results A total of 250 patients were included (118 foam sclerotherapy, 132 EVTA). Baseline demographics and disease severity were similar between groups. Both treatments produced significant improvements in VCSS, VDS and AVVQ at 1 year follow-up (all p < .001), with no significant differences between groups in clinical or quality-of-life outcomes. EVTA demonstrated superior anatomical durability, with 1-year occlusion rates of 93.5% compared with 81.5% after foam sclerotherapy (log-rank p = .003). Treatment modality was the only independent predictor of recanalization on multivariable analysis. Perioperative pain, recovery time, and sick leave were comparable between groups. Sensory nerve injury occurred in 6.3% of EVTA patients and in none of those treated with sclerotherapy ( p = .053). At 1-month follow-up, absence of visible/residual varicosities was observed in 97.0% of EVTA-treated limbs and 88.1% of limbs treated with catheter-directed foam sclerotherapy, while clinical scores and quality-of-life outcomes improved significantly in both groups. Sensory nerve injury occurred only after EVTA and was not observed after foam sclerotherapy. Conclusions EVTA provides greater anatomical durability than catheter-directed foam sclerotherapy for treatment of GSV reflux. However, both techniques result in comparable improvements in symptoms, disability, quality of life, and clinical appearance of varicosities. Foam sclerotherapy may offer a safe, less resource-intensive, and potentially cost-effective alternative for selected patients or in resource-limited settings.