Recanalization Rates and Complications of Post-Endovenous Microwave Ablation in Chronic Vein Insufficiency with Large GSV Diameter
Main Article Content
Endovenous Microwave Ablation (EMA) is one of the thermal ablation modalities to treat chronic venous insufficiency (CVI). The effectiveness and safety of EMAs in large-diameter saphena magna veins (GSVs) still require further research. This study aimed to compare the rates of recanalization and post-EMA complications in CVI patients with GSV diameters of <8 mm and ?8 mm. This retrospective cohort study used data from 54 patients from a multicenter (January 2023 – May 2025). Statistical analysis was performed with an unpaired t-test and a Chi-square test. The rate of venous occlusion reached 100% in both groups. The recanalization rate at 3 months post-procedure was higher in the GSV group ?8 mm (11.1%) compared to the GSV <8 mm (3.7%), although the difference was not statistically significant (p=0.299). There were no significant differences in complications of ecchymosis, thermal skin injury, and paresthesia. However, pain was reported to be significantly higher in the ?8 mm GSV group (33.3% vs 7.4%; p=0.018). The EMA is effective in achieving occlusion in a wide range of GSV diameters, but patients with a GSV of ?8 mm (especially ?10 mm) have a higher tendency to recanalize and post-procedure pain. Additional strategies are needed to be considered to increase effectiveness and comfort in the group.
Keywords:
Endovenous Microwave Ablation (EMA), Chronic Venous Insufficiency (CVI), large vein diameter, efficacy, complication
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23. DePopas E BM. Varicose Veins and Lower Extremity Venous Insufficiency. Semin Intervent Radiol. 2018;35(1):56–61.
24. Taylor J, Hicks CW HJA. The hemodynamic effects of pregnancy on the lower extremity venous system. J Vasc Surg Venous Lymphat Disord. 2018;6(2):246–55.
25. Chamanga ET. Understanding venous leg ulcers. Br J Community Nurs. 2018;23(9):6–15.
26. Tsai, S. et al. Severe chronic venous insufficiency: magnitude of the problem and consequences. Ann Vasc Surg. 2005;19(5):705–11.
27. Sutzko DC, Obi AT, Kimball AS, Smith ME, Wakefield TW ONH. Clinical outcomes after varicose vein procedures in octogenarians within the Vascular Quality Initiative Varicose Vein Registry. J Vasc Surg Venous Lymphat Disord. 2018;6(4):464–70.
28. Kavousi Y, Al Adas Z, Karamanos E, Kennedy N, Kabbani LS LJC. Men present with higher clinical class of chronic venous disease before endovenous catheter ablation. J Vasc Surg Venous Lymphat Disord. 2018;6(6):702–6.
29. K?l?nç F, Akba? A, ?ener S, Hayran Y, Akta? A. Cutaneous findings in patients with chronic venous insufficiency. J Cosmet Dermatol. 2022;21(5):2106–12.
30. Li AY, Tong E, Yedavalli VS. A Case-Based Review of Cerebral Venous Infarcts With Perfusion Imaging and Comparison to Arterial Ischemic Stroke. Frontiers in Radiology. 2021;1(October):2–7
2. De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, et al. European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. J Vasc Surg. 2022 Mar;75(3):1119.
3. Zhao N, Guo H, Zhang Y, Hu X, He J nan, Wang D, et al. Comparison of endovenous microwave ablation versus radiofrequency ablation for lower limb varicose veins. J Vasc Surg Venous Lymphat Disord. 2024;12(1).
4. Sevil F, Colak A, Ceviz M, Kaya U, Becit N. The Effectiveness of Endovenous Radiofrequency Ablation Application in Varicose Vein Diseases of the Lower Extremity. Cureus. 2020;
5. Ivano Kalaij AG, Zahrani S, Saputro KB, Suwana AG, Taofan T, Indriani S, et al. Efficacy and Safety of Endovenous Microwave Ablation versus Endovenous Laser Ablation for Varicose Veins in Chronic Great Saphenous Vein Insufficiency: A Meta-Analysis. Ann Vasc Surg [Internet]. 2025 Jan 23 [cited 2025 Feb 11]; Available from: https://linkinghub.elsevier.com/retrieve/pii/S0890509625000251
6. Theivacumar NS, Dellagrammaticas D, Beale RJ, Mavor AID, Gough MJ. Factors Influencing the Effectiveness of Endovenous Laser Ablation (EVLA) in the Treatment of Great Saphenous Vein Reflux. European Journal of Vascular and Endovascular Surgery. 2008;35(1).
7. Kemalo?lu C. Saphenous vein diameter is a single risk factor for early recanalization after endothermal ablation of incompetent great saphenous vein. Vascular. 2019;27(5).
8. Brittenden J, Cooper D, Dimitrova M, Scotland G, Cotton SC, Elders A, et al. Five-Year Outcomes of a Randomized Trial of Treatments for Varicose Veins. New England Journal of Medicine. 2019;381(10).
9. Desmyttère J, Grard C, Wassmer B, Mordon S. Endovenous 980-nm laser treatment of saphenous veins in a series of 500 patients. J Vasc Surg. 2007;46(6).
10. Gibson K, Ferris B. Cyanoacrylate closure of incompetent great, small and accessory saphenous veins without the use of post-procedure compression: Initial outcomes of a post-market evaluation of the VenaSeal System (the WAVES Study). Vascular. 2017;25(2).
11. Woo HY, Kim SM, Kim D, Chung JK, Jung IM. Outcome of ClosureFAST radiofrequency ablation for large-diameter incompetent great saphenous vein. Vol. 96, Annals of Surgical Treatment and Research. 2019.
12. Li Z, Wang M, Wu R, Wang Z, Yan J, Yao C, et al. Efficacy of endovenous microwave ablation in treating primary varicose veins of the lower extremities. National Medical Journal of China. 2021;101(39).
13. O’Donnell TF, Balk EM, Dermody M, Tangney E, Iafrati MD. Recurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials. Vol. 4, Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2016.
14. Kheirelseid EAH, Crowe G, Sehgal R, Liakopoulos D, Bela H, Mulkern E, et al. Systematic review and meta-analysis of randomized controlled trials evaluating long-term outcomes of endovenous management of lower extremity varicose veins. Vol. 6, Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2018.
15. Yun S, Hwang MO. Post-Operative Follow-Up with Ultrasound after Varicose Vein Ablation. Annals of Phlebology. 2023 Dec 31;21(2):85–9.
16. Yang L, Wang X, Wei Z, Zhu C, Liu J, Han Y. The clinical outcomes of endovenous microwave and laser ablation for varicose veins: A prospective study. Surgery (United States). 2020;168(5).
17. Chen H, Wang C, Ye S, Wang L, Li X, Kong L, et al. One-stop endovenous laser ablation leads to superior outcomes for varicose veins and iliac vein compression. Sci Rep [Internet]. 2025 Dec 1 [cited 2025 Jul 2];15(1):1313. Available from: https://pubmed.ncbi.nlm.nih.gov/39779899/
18. Nemoto H, Mo M, Ito T, Inoue Y, Obitsu Y, Kichikawa K, et al. Venous thromboembolism complications after endovenous laser ablation for varicose veins and role of duplex ultrasound scan. J Vasc Surg Venous Lymphat Disord [Internet]. 2019 Nov 1 [cited 2025 Jul 2];7(6):817–23. Available from: https://www.sciencedirect.com/science/article/pii/S2213333X19304056
19. Eberhardt RT, Raffetto JD. Chronic venous insufficiency. Circulation. 2014;130(4):333–46.
20. Raffetto J ER. Chronic venous disorders: general considerations. In: Rutheford’s Textbook of Vascular Surgery. 7th ed. Philadelphia: Saunders Elsevier; 2010. p. 831–43.
21. Berti-Hearn L, Elliott B. Chronic venous insufficiency: A review for nurses. Nursing (Brux). 2019;49(12):24–30.
22. Gloviczki P, Dalsing MC, Henke P et al. Report of the Society for Vascular Surgery and the American Venous Forum on the July 20, 2016 meeting of the Medicare Evidence Development and Coverage Advisory Committee panel on lower extremity chronic venous disease. J Vasc Surg Venous Lymphat Disord. 2017;5(3):378–98.
23. DePopas E BM. Varicose Veins and Lower Extremity Venous Insufficiency. Semin Intervent Radiol. 2018;35(1):56–61.
24. Taylor J, Hicks CW HJA. The hemodynamic effects of pregnancy on the lower extremity venous system. J Vasc Surg Venous Lymphat Disord. 2018;6(2):246–55.
25. Chamanga ET. Understanding venous leg ulcers. Br J Community Nurs. 2018;23(9):6–15.
26. Tsai, S. et al. Severe chronic venous insufficiency: magnitude of the problem and consequences. Ann Vasc Surg. 2005;19(5):705–11.
27. Sutzko DC, Obi AT, Kimball AS, Smith ME, Wakefield TW ONH. Clinical outcomes after varicose vein procedures in octogenarians within the Vascular Quality Initiative Varicose Vein Registry. J Vasc Surg Venous Lymphat Disord. 2018;6(4):464–70.
28. Kavousi Y, Al Adas Z, Karamanos E, Kennedy N, Kabbani LS LJC. Men present with higher clinical class of chronic venous disease before endovenous catheter ablation. J Vasc Surg Venous Lymphat Disord. 2018;6(6):702–6.
29. K?l?nç F, Akba? A, ?ener S, Hayran Y, Akta? A. Cutaneous findings in patients with chronic venous insufficiency. J Cosmet Dermatol. 2022;21(5):2106–12.
30. Li AY, Tong E, Yedavalli VS. A Case-Based Review of Cerebral Venous Infarcts With Perfusion Imaging and Comparison to Arterial Ischemic Stroke. Frontiers in Radiology. 2021;1(October):2–7
