Clinical outcomes and feasibility of nonthermal, nontumescent ablation for isolated below-the-knee great saphenous vein incompetence.

OBJECTIVE

The aim of this study was to assess feasibility, clinical outcomes, and safety of nonthermal, nontumescent (NTNT) ablation for symptomatic isolated below-the-knee (BTK) great saphenous vein (GSV) incompetence with competent saphenofemoral junction and above-knee GSV.

METHODS

This multicenter retrospective study included 73 treated BTK-GSV limbs in 50 patients who underwent NTNT ablation (mechanochemical ablation or cyanoacrylate adhesive closure) between October 2020 and April 2025. Isolated BTK-GSV incompetence was defined as reflux ≥1.0 second confined to the BTK segment on duplex mapping without junctional or above-knee truncal reflux. Follow-up duplex ultrasound and Venous Clinical Severity Score assessments were performed at 1 week and 1, 3, 6, and 12 months.

RESULTS

Immediate postprocedural duplex ultrasound confirmed complete occlusion of the treated BTK-GSV segment in all limbs. No partial or complete recanalization was observed during follow-up. The median Venous Clinical Severity Score improved significantly from 4 (interquartile range [IQR], 3-4) at baseline (n = 73) to 0 (IQR, 0-1) at 1 week (n = 51), 0 (IQR, 0-1) at 1 month (n = 73), 0 (IQR, 0-1) at 3 months (n = 73), 0 (IQR, 0-0) at 6 months (n = 73), and 0 (IQR, 0-0) at 12 months (n = 43) (all P < .001 vs baseline; Wilcoxon signed-rank test). No major adverse events occurred, including deep vein thrombosis, pulmonary embolism, or permanent paresthesia suggestive of saphenous nerve injury. Minor events included superficial phlebitis (8%), ecchymosis (7%), and skin rash related to bandages or compression stockings (7%), all resolving with conservative management.

CONCLUSIONS

NTNT ablation appears to be a safe and effective option for symptomatic isolated BTK-GSV reflux, providing significant clinical improvement with durable occlusion and without thermal-related nerve injury.