Abstract
Venous thrombosis prophylaxis after endovenous and open surgery for varicose veins: A systematic review and network meta-analysis
Ye S, Chen J, Ju J, Yang L. Vasc Endovascular Surg. 2025 Dec 22
The authors’ aim was to evaluate the efficacy and safety of pharmacologic thromboprophylaxis following endovenous and open surgical treatment of varicose veins. A systematic review and network meta-analysis of randomized and observational studies was performed, comparing different anticoagulant agents and prophylaxis durations with respect to postoperative venous thromboembolism and bleeding outcomes. Eleven studies including 7359 patients were analyzed. Pharmacologic prophylaxis demonstrated a nonsignificant trend toward reduced venous thromboembolism compared with no prophylaxis and was not associated with a significant increase in bleeding. Network meta-analysis showed no significant differences among low-molecular-weight heparin, rivaroxaban, apixaban, unfractionated heparin, or sulodexide, and no superiority of prophylaxis durations of 3, 5, or 10 days for preventing thromboembolic events or bleeding complications.
The authors conclude that postoperative anticoagulant prophylaxis after varicose vein interventions appears safe, but its effectiveness in reducing venous thromboembolism remains uncertain, underscoring the need for large, well-powered randomized trials to define the optimal agent, dose, and duration.
Understanding recurrence in pelvic venous disorders through the SVP classification: A multicenter prospective cohort study
Yamamoto-Ramos M, De Gregorio MA, de Blas I, Sierre S, Urbano J, Méndez S, Abadal JM, Pérez-Lafuente M, Aguirre N, Guirola JA. Vasc Interv Radiol. 2026 Mar 25, 2026
The authors’ purpose of this study was to identify components of the Symptoms-Varices-Pathophysiology (SVP) classification predictive of clinical recurrence after embolization of the four major pelvic venous axes in patients with pelvic venous disorders (PeVD). This prospective multicenter cohort study included women with PeVD treated at six hospitals using a unified diagnostic, embolization, and follow-up protocol. Clinical, anatomical, and hemodynamic variables were classified according to the SVP system. Recurrence was defined as clinical worsening with a ≥1-category increase in visual analog scale score, associated with duplex ultrasound evidence of directed reflux and venographic confirmation of an active escape pathway. 244 patients, 117 (48.0%) developed clinical recurrence during 24 months of follow-up. Non-saphenous lower-extremity varices (V3b) were present in 75.8% of the cohort which were strongly associated with recurrence. Patients with V3b varices had higher re-embolization rates (52.4% vs 34.5%; RR = 1.52; p = 0.016). On multivariate analysis, V3b was the only independent predictor of recurrence (odds ratio = 16.16; 95% confidence interval: 5.23-49.92; p < 0.001). Recurrence occurred earlier and more frequently in patients with V3b varices, with reduced recurrence-free survival on Kaplan-Meier analysis (hazard ratio = 2.56; p < 0.001).
The authors concluded that V3b varices are the strongest independent predictor of clinical recurrence after embolization for PeVD, representing a compensated hemodynamic phenotype with persistent extrapelvic decompression. Identification and targeted treatment of these escape pathways should be incorporated into diagnostic and therapeutic strategies.
Frequency of inappropriate endovenous truncal ablation therapy within the VQI varicose vein registry
Fassler MJ, Góngora A, Stinson G, Neal D, Osborne NH, Robinson ST, Scali ST, Jacobs BN. J Vasc Surg Venous Lymphat Disord 2026 Mar 25
The authors’ purpose of this study was to investigate trends in endovenous truncal ablation (EVTA) therapies and ascertain trends in compliance with appropriate use criteria utilizing the VQI Varicose Vein Registry (VQI-VVR. The authors hypothesized that variation would exist in venous disease treatment patterns, and that treatment location and insurance status would influence the likelihood of nonconformity with these guidelines. Chronic venous disease is a pervasive problem, with a spectrum of severity and a diverse range of potential treatment settings and proceduralists. The adoption of endovenous ablation (EVA) techniques has facilitated growth in office-based and ambulatory procedures. Concurrently, the impact of external factors including market compensation and insurance policies is known to influence procedural patterns away from evidence-based therapy. Patients undergoing EVTA procedures from participating VQI centers between January 2015 and September 2022 were identified. Procedures limited to perforator ablation, remnant or recanalized veins, or stab phlebectomy alone were excluded, as well as procedures performed on patients failing to meet VQI-VVR inclusion criteria. The primary objective was to evaluate practice variation and identify factors associated with non-compliance with 2020 AVF/SVS/AVLS/SIR Appropriate Use Criteria (AUC). Secondary objectives compared outcomes between patients treated in accordance with versus outside of guideline recommendations. A total of 32,558 procedures were analyzed and stratified into appropriateness subgroups. Procedures in which all treated veins were guideline appropriate interventions comprised 90.1% of the cohort. Interventions with at least one treatment designated as rarely appropriate or never appropriate guideline therapy comprised 1.8% and 1.3% of the cohort respectively. Comparative analysis between appropriate and the inappropriate (i.e., rarely appropriate, and never appropriate) treatment revealed prior varicose vein intervention (OR: 2.4 [2.0−2.9]; p < 0.0001) and non-white race (OR: 2.1 [1.7−4.2]; p < 0.0001) was associated with receiving a never appropriate treatment. Office-based settings (OR: 2.7 [1.9−4.0]; p < 0.0001) and bilateral interventions (OR: 1.9 [1.2−2.9]; p = 0.003) were associated with never appropriate treatment. Increasing the number of veins treated was positively associated with inappropriate treatment (3 [1, 2] vs 3 [2, 4]; p < 0.0001 and 2 [1, 2] vs 2 [2, 4]; p < 0.0001). Most patients were privately insured (70%); however, there was no association between insurance status and off-guideline therapy. Center-level analysis revealed that 38% of all inappropriate procedures occurred at four centers.
The authors concluded that the analysis demonstrates a low incidence of inappropriate EVTA procedures. Moreover, these findings underscore the importance of continued education and quality improvement efforts to ensure adherence to evidence-based guidelines for venous ablation.
Effectiveness and limitations of endovenous laser ablation for anterior saphenous vein insufficiency: A single-center retrospective study
Gruber E, Ranjbaryan M, El Jamal B, Karsai S, Debus ES, Müller L. J Clin Med. 2026 Feb 25;15(5):1733
The authors’ purpose of this study was to identify the effectiveness and limitations of endovenous laser ablation (EVLA) of the anterior saphenous vein (ASV) incompetence which represents the third most common form of truncal varicose veins. They evaluated outcomes of EVLA in cases with dominant ASV insufficiency. All EVLA procedures performed by a single surgeon between April 2019 and December 2023 for primary ASV reflux (ASV-R) were compared with a cohort containing all EVLA treatments for great saphenous vein (GSV) insufficiency without ASV reflux from April to December 2019 (GSV-R). A 1470-nm diode laser with a radial fiber was utilized for the interventions. 378 patients (mean age 49.5 years): 208 and 256 treated limbs in the ASV-R and GSV-R cohorts, respectively were included. Female patients were more frequent in the ASV-R cohort than in the GSV-R cohort (80.5% vs 62.9%, p < 0.001). ASV-R cases exhibited concomitant GSV insufficiency in 54.3% of cases. Redo procedures due to initial treatment failure were more frequent in ASV-R (1.9% vs 0%, p = 0.04). Over a mean follow-up period of 332 days, 16 recurrences occurred in the ASV-R cohort compared with four in the GSV-R cohort, corresponding to a significantly increased hazard of recurrence in ASV-R (HR 8.41, 95% CI 2.78−25.4). Rates of subsequent foam sclerotherapy (16.8% vs 10.5%) and minor complications (5.3% vs 4.3%) did not differ significantly between ASV-R and GSV-R, respectively. ASV-R cases without concomitant GSV reflux demonstrated a higher need for secondary sclerotherapy, compared to ASV-R cases with additional GSV insufficiency.
The authors concluded that EVLA for ASV insufficiency is technically more challenging and yields inferior outcomes than EVLA for GSV incompetence. These considerations should be taken into account during preoperative planning and patient counseling.
Five year follow up of mechanochemical ablation for the treatment of small saphenous vein incompetence
Baccellieri D, Ardita V, Valente FBA, Campesi C, Pizzutilli AC, Chiesa R. Eur J Vasc Endovasc Surg. 2026 Mar 16
The authors’ aim of this study was to continue to assess the effectiveness of mechanochemical ablation (MOCA) for treatment of small saphenous vein (SSV) incompetence at 3 and 5 years, building on preliminary results that showed feasibility, safety, and high occlusion rates at 1 year follow up. Sixty patients who underwent MOCA for SSV incompetence at a single center between January 2017 and December 2019 were included. Clinical and radiological data were retrospectively reviewed from a prospectively maintained database. Primary endpoints were SSV recanalization and re-intervention at 3 and 5 years. Additional outcome measures included Venous Clinical Severity Score (VCSS), Aberdeen Varicose Vein Questionnaire (AVVQ) and the visual analogue scale to assess pain during long term follow up, and signs and symptoms of chronic venous disease. 50 patients completed the full 5 years follow up with freedom from recanalization - 84.7% at 3 years and 66.5% at 5 years. Freedom from re-intervention at the same time points was 86.7% and 72.6%, respectively. Although the VCSS and AVVQ scores decreased during the first year, a progressive increase was observed over the follow-up period. The median VCSS increased significantly at 3 and 5 years. The AVVQ score increased from a median (interquartile range [IQR]) of 5.0 (IQR 3.0, 7.0) at 1 year to 8.2 (IQR 5.0, 11.0) at 3 years and 10.1 (IQR 6.0, 14.0) at 5 years (p < .001). Multivariate analysis identified body mass index >25 kg/m2 and pre-operative SSV diameter >6 mm as significant risk factors for SSV recanalization.
The authors concluded that treatment of SSV incompetence with MOCA revealed high 5-years recanalization and re-intervention rates. Additionally, a progressive decrease in QoL and deterioration of patient reported outcomes over time were identified.
Recanalization in large-diameter saphenous veins after thermal ablation: A retrospective review of vascular quality initiative data
Pisharody V, Gunasti J, Garcia I, Rajani RR, Ramos CR, Garcia-Toca M, Benarroch-Gampel J. Ann Vasc Surg. 2026 Feb;123:199–206. doi: 10.1016/j.avsg.2025.09.037
In this study, the authors evaluated whether large-diameter saphenous veins were associated with higher recanalization rates after thermal ablation. Using data from the Vascular Quality Initiative varicose vein module, they identified patients who underwent thermal ablation of the great or small saphenous veins between 2015 and 2019. Demographic data, vein diameter, procedural details, and postoperative outcomes were analyzed, and patients were divided into large-vein (≥10 mm) and small-vein cohorts. A total of 16,937 procedures performed in 13,263 patients were included in the analysis. The authors found that patients with large-diameter veins were more likely to develop hematomas (0.7% vs 0.4%, p = 0.0195) and superficial phlebitis (1.5% vs 0.8%, p < 0.001). However, no significant differences in other postoperative complications were observed between the two groups. In addition, symptom improvement after intervention was greater in the large-vein cohort (−7.47 vs −7.01 on the standardized Heaviness-Achiness-Swelling-Throbbing-Itching scale, p = 0.001). Cox proportional hazards modeling showed that large veins were not associated with worse recanalization-free survival (odds ratio, 0.74; p = 0.24).
The authors concluded that large saphenous vein diameter was not associated with an increased risk of recanalization after thermal ablation and that thermal ablation remains an appropriate first-line treatment option for large veins.
Fourteen year outcomes of a randomised controlled trial comparing endovenous laser ablation, high ligation and stripping, and ultrasound guided foam sclerotherapy for great saphenous varicose veins
Rahman T, Noronen K, Vähäaho S, Halmesmäki K, Venermo M. Eur J Vasc Endovasc Surg. 2026 Feb 1:S1078-5884(26)00093-6. doi: 10.1016/j.ejvs.2026.01.056.
The authors’ aim was to compare the 14-years outcomes of high ligation and stripping (HLS), endovenous laser ablation (EVLA), and ultrasound-guided foam sclerotherapy (UGFS) in patients with symptomatic great saphenous vein (GSV) reflux. Patients were randomized in a 1:1:1 ratio to receive one of the three treatments, and 196 patients treated at Helsinki University Hospital were invited to a 14-years follow-up. The primary outcomes were above-knee GSV reflux and re-intervention rates, while secondary outcomes included quality of life. Of 233 randomized patients, 214 were included in the analysis. The authors found that UGFS was associated with a significantly higher risk of recurrent GSV reflux compared with both HLS (RR 11.7, 95% CI 1.6–85.6) and EVLA (RR 5.0, 95% CI 1.5–16.6), with recurrent reflux rates of 30.8% after UGFS versus 2.6% after HLS and 6.1% after EVLA (overall p < .001). UGFS was also associated with significantly higher re-intervention rates compared with HLS (RR 4.3, 95% CI 1.8–10.2) and EVLA (RR 6.9, 95% CI 2.6–18.4), occurring in 56.4% of UGFS patients versus 13.2% of HLS patients and 8.2% of EVLA patients (overall p < .001). In contrast, neovascularisation rates did not differ significantly among the three treatment groups (29.0%, 22.5%, and 23.1%, respectively; overall p = .76). Quality of life, assessed using the Aberdeen Varicose Vein Questionnaire, was comparable across all groups (overall p = .21).
The authors concluded that UGFS showed inferior long-term outcomes for recurrent GSV reflux and re-intervention rates compared with both HLS and EVLA, whereas HLS and EVLA demonstrated similar long-term performance, with comparable quality of life across all treatment groups.
Ablation length, not modality type, determines healing outcomes in venous leg ulcers
Kiguchi MM, Campat CA, Bejugam D, Jimenez JC, Sachdev U, Bhatt N, Rothstein A, Bitner J, O'Banion LA. J Vasc Surg Venous Lymphat Disord. 2026 Jan;14(1):102308. doi: 10.1016/j.jvsv.2025.102308.
The authors compared wound-healing outcomes after primary nonthermal ablation with cyanoacrylate glue (CAG) or commercial polidocanol microfoam ablation (MFA), and thermal ablation with adjunct MFA in patients with venous leg ulcers. In this multicenter retrospective cohort study, patients with healed venous ulcers after nonthermal endovenous treatment were identified from four tertiary referral US institutions. Patients whose full-length great saphenous vein was treated with a single nonthermal modality (CAG or MFA) were compared with those treated with radiofrequency ablation plus MFA of the below-knee segment. Demographic, comorbidity, procedural, and wound data were collected, and multivariate linear regression was performed to identify predictors of wound healing. A total of 55 patients were included, of whom 27 underwent primary CAG or MFA, and 28 underwent radiofrequency ablation plus MFA. The average age was 70 ± 12 years, 56% were male, and 53% had a body mass index >30 kg/m2. Comorbidities were similar between the cohorts. The median ulcer size was 3 cm2. The median time to wound healing was 61 days (interquartile range, 30−258 days) with no significant difference between treatment modalities (p = 0.37), irrespective of ulcer size category. The rate of ulcer recurrence was 16% and did not differ between the cohorts (p = 0.46). Multivariate linear regression identified proximal access site as the only independent predictor of prolonged wound healing (p = 0.03).
The authors concluded that treatment of the full-length GSV with a single nonthermal modality (CAG or MFA) and treatment with radiofrequency ablation plus below-knee MFA resulted in comparable times to wound healing, suggesting that comprehensive treatment of the entire GSV to the ankle, irrespective of modality, is the preferred approach for optimal wound healing in CEAP class 6 patients.