Comparison of therapeutic effects of ultrasound-guided radiofrequency ablation and high ligation and stripping of great saphenous vein in the treatment of varicose veins of lower limbs and analysis of recurrence factors

Corresponding author: 成青鉴, qfqsjq@163.com

DOI: 10.12201/bmr.202602.00026

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  Abstract: Objective: The purpose of this research is to assess the clinical effectiveness of radiofrequency ablation (RFA) versus high ligation and stripping (HL/S) in the management of lower extremity varicose veins (LEVV), and to explore the factors contributing to recurrence using SHAP analysis. Methods: A total of 240 LEVV patients admitted to our hospital between December 2023 and December 2024 were recruited and allocated into two cohorts: the RFA group (n = 120) and the HL/S group (n = 120). The two groups were compared with respect to surgery-related parameters, postoperative Visual Analog Scale (VAS) scores, coagulation indices after surgery, Venous Clinical Severity Score (VCSS), Venous Appearance and Quality of Life Questionnaire (VAVQ) scores, as well as the incidence of complications and recurrence at 12 months following the operation. Results: Compared with the HL/S group, the RFA group exhibited notably less intraoperative blood loss, shorter operation duration, and reduced hospital stay (P<0.05). Postoperative VAS scores were lower in the RFA group than in the HL/S group, indicating milder postoperative pain. No significant differences were observed in the levels of plasminogen activator inhibitor-1 (PAI-1) and fibrinogen (FIB) between the two groups preoperatively; however, the RFA group had substantially lower PAI-1 and FIB levels on the 3rd postoperative day. At 6 months after surgery, there was no statistically significant difference in VCSS scores between the two groups, but at 12 months, the VCSS of the RFA group was significantly lower than that of the HL/S group (P<0.05). Both groups showed marked improvements in VAVQ scores after surgery, with no significant intergroup difference (P>0.05). The total complication rate in the RFA group was 10.83%, which was significantly lower than the 30.83% in the HL/S group (P<0.05). There were no significant differences in recurrence rates between the two groups at 6 and 9 months postoperatively; however, at 12 months, the recurrence rate of the RFA group was 11.77%, significantly lower than the 25.0% in the HL/S group (P<0.05). SHAP analysis revealed the top five key variables affecting recurrence risk: (1) Coagulation dysfunction: Impaired coagulation status was associated with an elevated recurrence risk; (2) Body Mass Index (BMI): Higher BMI correlated with increased recurrence risk; (3) Age: Patients younger than 45 years had a lower recurrence risk, while those older than 60 years faced a higher risk; (4) Great saphenous vein diameter: A vein diameter exceeding 9mm heightened the recurrence risk; (5) CEAP classification: Patients with CEAP C4-C5 (moderate-risk group) had a higher recurrence risk compared to those with lower classifications. Conclusion: In the treatment of LEVV, RFA is more effective than HL/S. It remarkably enhances clinical outcomes, reduces the incidence of complications, and lowers the recurrence rate. Strengthening preoperative assessments and optimizing postoperative rehabilitation protocols can further help mitigate the risk of recurrence.

  Key words: varicose; veins of; lower limbs, radiofrequency; ablation, high; ligation and; stripping, SHAP; analysis, recurrence

  Submit time: 8 February 2026

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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