Endovascular treatment of the small saphenous vein: comparison between laser ablation and radiofrequency - real-life cases from two Italian centers

Thermal endovascular techniques, including Endovenous Laser Ablation (EVLA) and Radiofrequency Ablation (RFA), have currently progressively replaced traditional surgery in the treatment of venous insufficiency. Despite this, the literature on the Small Saphenous Vein (SSV) remains heterogeneous, due to the anatomical variability of the venous course, its proximity to the sural nerve, and the limited duration of available follow-up. The purpose of this study is to review the literature of recent years in endovascular treatment of SSV and analyze real-life cases from two Italian centers. Forty-two patients treated between August 2021 and October 2025 were included: 24 underwent RFA at the Policlinico di Milano and 18 treated with EVLA at the Manerbio Hospital. The variables considered included additional procedures for varicose vein treatment, type of anesthesia, and length of stay. The primary outcomes included the rate of ultrasound-guided occlusion, the occurrence of perioperative and postoperative complications, such as sural nerve neuropathy, Endovenous Heat-Induced Thrombosis (EHIT), bleeding, bruises, and infections, and the need for further treatments during the subsequent follow up. Concurrent varicose vein treatment was more frequent in the RFA group, with varying techniques. Local anesthesia was the most commonly used method, and the average hospital stay was one day. Both centers reported a 100% occlusion rate, with no recanalizations or need for reoperation. No major complications were observed, and no damage to the sural nerve was recorded. EVLA and RFA have been confirmed as safe and effective techniques for the treatment of SSV insufficiency in a real-world setting. The choice of method appears to be determined primarily by the center's experience, the technology availability, and the patient's anatomical characteristics, ensuring high efficacy and a comparable safety profile.