Comparative outcomes of radiofrequency endoluminal ablation, invagination stripping, and cryostripping in the treatment of great saphenous vein insufficiency

Objective: Prospective, randomized comparison of short-term and one-year postoperative outcomes after radiofrequency endoluminal ablation (REA) of the great saphenous vein (GSV), saphenofemoral junction (SFJ) ligation with extended tributary ligation and invagination GSV stripping, and SFJ ligation with extended tributary ligation and GSV cryostripping. Methods: In all, 60 consenting patients were randomly allocated to three groups and treated contemporaneously over a nine-month period. Clinical, duplex Doppler, analogue scale pain scoring and activity impairment assessments were performed one day postoperatively, and after one, two, and six weeks, and then repeated after one year, adding patient satisfaction scoring and the CIVIQ 2 quality-of-life questionnaire, specifically designed for lower limb venous insufficiency. Results: Immediate success was achieved in 19/20 REA limbs with one open segment that subsequently spontaneously closed, in 20/20 invagination stripping limbs, and in 18/20 cryostripped limbs, two having residual open segments. Cumulative up to six-week impairment scores, cumulative up to six-week pain scores, and time to return to full activity were all statistically superior for REA patients. At one year, segmental recanalization on less than 10 cm was detected in two REA patients, and for all REA patients the GSV trunk was sonographically no longer visible, beginning from 10 cm below the SFJ. REA patients continued to be significantly more satisfied with both their operative procedures and the cosmetic appearance of their treated lower extremity compared with patients in the two other treatment cohorts. Conclusion: REA offers significant short-term, patient-oriented advantages over extended ligation and invagination or cryostripping through one year.