Flush versus Standard Radiofrequency Ablation of the Great Saphenous Vein: Single-Center Experience

Background and Objective: Radiofrequency ablation (RFA) is an established treatment for great saphenous vein (GSV) incompetence. However, neovascularization and residual reflux at the saphenofemoral junction (SFJ) remain concerning. Flush ablation, in which energy delivery is initiated directly after the SFJ, may improve outcomes. The objective was to compare clinical outcomes, pain, quality of life (QoL), and complications between flush and conventional standard RFA of the GSV. Methods: A prospective randomized comparative study was conducted on patients undergoing endovenous RFA, using flush and conventional standard ablation between January 2020 and December 2024 at a tertiary referral center. The primary endpoint was the change in pain score (Visual Analog Scale [VAS]) at 6 months. Secondary endpoints included QoL, recurrence, neovascularization, and endovenous heat-induced thrombosis (EHIT) ≥2. Results: A total of 602 consecutive patients were treated with RFA, divided into 2 equal groups: flush ablation (Group F, n = 301) and standard ablation (Group S, n = 301). Post-procedural pain scores were significantly lower in Group F compared with Group S (42.3 ± 6.9 vs 48.9 ± 8.0, P < .001), with a greater percentage reduction from baseline (33.1% vs 22.4%). In a median follow-up of 20 months, neovascularization occurred significantly less frequently in Group F (0.7% vs 4.0%, P = .012). Recurrence rates were low and comparable between groups (2.0% vs. 4.0%, P = .231). No deep vein thrombosis (DVT) occurred in Group F, while 1 case was reported in Group S. Conclusion: Flush RFA of the great saphenous vein was associated with significantly improved postoperative pain compared with conventional ablations. Lower rates of neovascularization were also observed. No increase in thrombotic or procedural complications was identified in this cohort. Given that this approach extends beyond current standard practice and considering the limited power for rare adverse events, these findings require confirmation in larger multicenter studies with longer follow-up before widespread adoption can be recommended. Clinical Impact Flush radiofrequency ablation represents a simple technical modification of standard endovenous therapy for great saphenous vein incompetence. By initiating ablation at the saphenofemoral junction under ultrasound guidance, this approach minimizes the residual venous stump and is associated with lower postoperative pain scores and a reduced rate of neovascularization, without an observed increase in thrombotic or procedural risk. Importantly, the absolute reduction in pain was modest, and the study was not powered for rare adverse events. As the technique can be implemented without additional equipment or cost, it offers a practical refinement of current workflows. These findings support further evaluation of a more proximal ablation strategy in larger multicenter studies to confirm its clinical benefit and long-term durability.