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

BACKGROUND

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 (Clinical-Etiological-Anatomical-Pathophysiological [CEAP] class C3-C4b) between January 2022 and December 2024. To mitigate selection bias, propensity score matching was executed utilizing 8 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-hr 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).

CONCLUSION

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 HL did not confer a detectable clinical advantage for CEAP C3-C4b GSV incompetence; however, longer-term follow-up is warranted.