Radiofrequency ablation with versus without high ligation for primary varicose veins of the great saphenous vein: A comparison of efficacy and outcomes

Purpose This study compares radiofrequency ablation (RFA) with versus without high ligation (HL) for treating primary varicose veins of the great saphenous vein, assessing differences in surgical efficacy. Method In this retrospective cohort study, consecutive patients with lower-extremity varicose veins treated at a single vascular center (July 2023–July 2024) were allocated to RFA (n = 65) or RFA ablation with high ligation (RFA + HL, n = 72). Groups were compared for operative time, blood loss, postoperative pain, hospital stay, symptom relief, and 2-year recanalization and recurrence rates. Results Both RFA and RFA + HL demonstrated favorable therapeutic outcomes, with significant symptom improvement observed in all patients postoperatively. The RFA group demonstrated superior perioperative outcomes, including shorter operative time (60.46 ± 7.89 vs. 65.21 ± 8.28 min, p = 0.001), less blood loss (11.92 ± 5.50 vs. 14.46 ± 6.94 mL, p = 0.020), lower postoperative VAS scores at 1d and 3d ( p < 0.01), a shorter hospital stay (2.15 ± 0.67 vs. 2.39 ± 0.64 days, p = 0.037), and a lower incidence of impaired wound healing (0.0% vs. 9.7%, p = 0.014). In contrast, RFA + HL provided better long-term durability, with significantly lower recanalization rates at both 9-month (1.4% vs. 10.8%, p = 0.027) and 12-month (2.8% vs. 12.3%, p = 0.047) follow-ups, as well as at 18-month (2.8% vs. 13.8%, p = 0.017) and 24-month (4.2% vs. 16.9%, p = 0.014) follow-ups. Notably, by 24 months postoperatively, clinical recurrence had occurred in 6 patients (9.2%) in the RFA group but none in the RFA + HL group ( p = 0.010). Conclusion Compared with RFA alone, the combination of RFA and HL for treating GSV incompetence was associated with a longer operative time and a higher risk of incision-related complications in the groin. However, the combined procedure demonstrated a lower venous recanalization rate at the 1-year follow-up, suggesting superior long-term durability of GSV closure.