A recent pilot feasibility study published in Phlebology (2025; DOI: 10.1177/02683555251413661) by Paolo Casoni, Emanuele Nanni, Matteo Pizzamiglio and Daniele Bissacco reports encouraging early outcomes using High-Intensity Focused Ultrasound (HIFU) to treat incompetence of the small saphenous vein (SSV).
The investigators treated a broad cohort of 292 legs with chronic venous disease, of which 15 (5.1%) had confirmed SSV insufficiency and were included in this dedicated analysis. All SSVs subjected to HIFU demonstrated competent closure or shrinkage at all follow-up intervals, from one week through 12 months after treatment.
Quality of life, measured via the CIVIQ-20 questionnaire, showed a significant improvement at three months post-treatment, with scores decreasing from 38.9 ± 9.1 to 24.3 ± 2.0 (p < 0.01). The revised Venous Clinical Severity Score (rVCSS) also trended favourably, declining from 6.5 ± 1.7 to 5.0 ± 1.0, though this change did not reach statistical significance. Notably, there were no reports of recurrent varicose veins in the treated SSV cohort throughout the follow-up period, underlining the potential durability of the HIFU effect.
HIFU offers a non-invasive alternative to traditional catheter-based techniques by delivering focused thermal energy without intravascular instrumentation. This approach may be particularly relevant for veins that are anatomically difficult to access, including SSV segments, where tortuosity or small calibre can pose challenges for conventional endovenous ablation.
Although this pilot study is limited by sample size and its observational nature, the consistent closure and symptom improvements observed over 12 months highlight HIFU’s potential as a viable treatment modality for SSV incompetence. Further larger-scale, comparative research will be needed to better define its role alongside existing thermal and non-thermal interventions.
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