Ablation Technique Research Articles

Current state of education in venous diseases within vascular surgery training programs in Italy: A national web-based survey among residents

Background To analyze the perception of vascular surgery trainees from Italian schools of Vascular Surgery regarding the level of practical and theoretical education in venous diseases. Methods An anonymous electronic survey was sent to Italian vascular surgery residents affiliated with 19 universities, asking about their training and experience in the management of venous diseases. The survey gathered information on the residents’ personal and demographic details, their university’s teaching program, operative experience in phlebology, as well as their confidence levels in performing various venous procedures, with the goal of analyzing the training and learning programs provided by Italian vascular surgery schools. Results The analysis showed that 28% of programs do not include phlebology in the curriculum, and more than 40% of residents are unable to independently perform venous duplex ultrasound or treat venous ulcers. Additionally, most residents (over 70%) have limited weekly exposure to phlebology cases, with only 5% having access to a dedicated phlebology operating room. The vast majority of residents (96%) expressed a strong desire to deepen their knowledge and skills in this field, particularly in areas such as endovascular ablation techniques, venous duplex ultrasound, and management of deep venous disease. Conclusions The survey reveals significant limitations in phlebology education and hands-on experience within the current training programs, highlighting the need to standardize and enhance venous disease management education in order to ensure that future vascular surgeons are adequately equipped to provide high-quality care for patients with a wide range of venous disorders.

Temperature-controlled synthesis of novel boron nanofibers by laser ablation technique

The synthesis of boron nanofibers (BNFs) at different temperatures using the double-pulsed laser ablation (DPLA) technique were reported. Q-switched Nd: YAG laser with 532 and 1064 nm dual beam wavelengths of laser used to ablate a solid boron target. A vapor–solid process at a furnace temperature and pressure supported boron 'nanofibers' growth with the active metal catalysts of 1 % Ni and 1 % Co in a quartz tube furnace in flowing argon (Ar) gas. The crystalline phase purity of the synthesized BNFs at 950, 1050, and 1150 °C were determined by X-ray diffraction (XRD), and the results from XRD confirm that each BNF is preferentially grown in the c-axis (100) direction of alpha boron (α-B). Electron microscopy revealed that each BNF exhibit a length of 1–5 μm and a diameter width of 5–100 nm, while the elemental chemical compositional nature of the BNFs is identified from energy dispersive X–ray spectroscopy (EDX). Image analysis shows the average diameter of each BNF synthesized to be 23.10, 19.13, and 16.09 nm. The lattice distance of each BNF is found to be 0.40, 0.39, and 0.38 nm, respectively. Fingerprint Raman spectroscopy revealed the fundamental vibrational modes of BNFs at Eg and A1g.

Ablation and laparoscopic adrenalectomy: Balancing efficacy and safety in the treatment of benign adrenal gland tumors: A systematic review and meta-analysis

BackgroundAldosterone-producing adenomas cause hypertension in 5–10 % of cases. Laparoscopic adrenalectomy is the gold standard treatment for early-stage adrenal gland tumors, but minimally invasive procedures, such as ablative techniques can also be applied. Therefore, we aimed to compare laparoscopic adrenalectomy and ablation techniques in terms of efficacy and safety in the treatment of benign adrenal gland tumors. Materials and methodsWe conducted a systematic search in five databases and included studies comparing the efficacy and safety of ablation techniques and laparoscopic adrenalectomy. We calculated odds ratios (ORs) for eligible studies with binary outcomes, and mean differences (MD) with 95 % confidence intervals (CI) for continuous outcomes. ResultsFive studies focusing on aldosterone-producing adenomas were included in our review. A total of 119 patients at 14 centers underwent ablation, and 161 patients had laparoscopic adrenalectomy. The complication rates (OR: 0.98, CI: 0.35–2.69) were similar in both groups, but among complications, hypertensive crisis (OR: 8.13; CI: 1.14–58.11) was more frequent in the ablative group, and even the success rate of interventions - the resolution of hypertension (OR: 0.30, CI: 0.16–0.56) - was lower in this group. On the other hand, the advantage of ablation was shorter intervention time (MD: 75.64 min; CI: 6.33–144.95), shorter hospital stay (MD: 1.6 days; CI: 0.88–2.31), and less perioperative blood loss (MD: 43.55 ml; CI: 12.07–75.04) compared to laparoscopy. ConclusionLaparoscopic adrenalectomy is still the best therapeutic approach, but ablation can be an appropriate alternative option for the treatment of aldosterone-producing adrenal gland tumors.

Short- and long-term outcomes in isolated vs. hybrid thoracoscopic ablation in patients with atrial fibrillation: a systematic review and reconstructed individual patient data meta-analysis.

Both isolated thoracoscopic and hybrid thoracoscopic atrial fibrillation (AF) ablation techniques have demonstrated favourable outcomes in the management of patients with (long-standing) persistent AF, as compared with catheter ablation. However, it is currently unknown whether there is a difference in short- and long-term outcomes when comparing these two minimally invasive surgical AF ablation procedures. Therefore, a systematic review and meta-analysis were performed to investigate these two techniques, with a specific emphasis on long-term freedom from atrial tachyarrhythmias (ATAs). A systematic search through PubMed, EMBASE, and the Cochrane Library databases was performed. All studies reporting on short-term outcomes were included in the meta-analysis. A pooled analysis of long-term freedom from ATA was performed based on Kaplan-Meier (KM) curve-derived individual patient data. Reconstructed individual time-to-event data were analysed in a multivariable Cox frailty model with adjustments for age, sex, type of AF, duration of AF history, and study variable (frailty term in the frailty Cox model). In total, 53 studies were included in the meta-analysis, encompassing 4950 patients. There were no differences in major short-term outcomes (mortality or stroke) between isolated thoracoscopic and hybrid thoracoscopic ablation. A total of 18 studies reported KM curves for long-term freedom from ATA, comprising 2038 patients. Adjusted analysis revealed that hybrid ablation was significantly associated with greater freedom from ATA [adjusted hazard ratio (aHR) = 0.59, 95% confidence interval (CI): 0.43-0.83, P < 0.001] compared with isolated thoracoscopic ablation. Additionally, older age (aHR = 1.07, 95% CI: 1.03-1.12, P = 0.002) and a higher percentage of male patients (aHR = 1.02, 95% CI: 1.01-1.03, P < 0.001) were significantly associated with lower long-term freedom from ATA recurrence. Hybrid thoracoscopic AF ablation is associated with a greater long-term freedom from ATA when compared with isolated thoracoscopic ablation, without differences in complications.

MRI accuracy for recurrence after partial gland ablation with HIFU for localized prostate cancer. A systematic review and meta-analysis.

Prostate cancer remains the most frequently diagnosed cancer among men. High-Intensity Focused Ultrasound (HIFU) has emerged as a thermal ablative technique for partial-gland-ablation (PGA), aiming to minimize collateral damage while maximizing tumor control. Monitoring after HIFU PGA relies on serial PSA testing, multiparametric-MRI, and biopsies. The diagnostic accuracy of MRI for clinically-significant cancer(csPCa) recurrence is challenging. This systematic review and meta-analysis aim to evaluate the accuracy of MRI in detecting early recurrence of localized prostate cancer following HIFU PGA. Adhering to PRISMA guidelines, a comprehensive literature search was conducted until May 8th 2024 using MEDLINE and Scopus. The inclusion criteria encompassed randomized controlled trials and cohort studies involving men diagnosed with localized prostate cancer who had as primary treatment HIFU PGA. The primary outcome measures included the sensitivity, specificity, positive-predictive value (PPV), and negative-predictive value (NPV) of MRI for csPCa(ISUP ≥ 2) based on biopsy results. We pooled data from studies with sufficient csPCa and csPCa-free patients (≥5) post HIFU for statistical analysis. Fifteen studies meet the inclusion criteria, encompassing 1093 patients and 12 studies were eligible for meta-analysis. MRI sensitivity in detecting clinically-significant prostate cancer (csPCa) recurrence post HIFU PGA varied widely (0-89%), with a pooled sensitivity of 0.52 (95% CI:0.36-0.68). Specificity ranged from 44% to 100%, with a pooled specificity of 0.81 (95% CI:0.68-0.91). The pooled NPV was 0.82 (95% CI:0.72-0.90), and the pooled PPV was 0.50 (95% CI:0.35-0.65). Three studies reported in-field diagnostic performance with sensitivities ranging from 0.42 to 0.80 and specificities from 0.45 to 0.97. MRI accuracy for clinically-significant recurrence after partial gland ablation with HIFU for localized prostate cancer shows low diagnostic performance in the treated lobe with pooled sensitivity of 0.52 (95% CI:0.36-0.68) and specificity of 0.81 (95% CI:0.68-0.91). Limits of this review include the low number of studies reporting about site of recurrence in or out of the treated lobe.

Meta-analysis of application of minimally-invasive ablation methods and classical surgical approach in osteoid osteoma and osteoblastoma

Abstract Osteoblastoma and osteoid osteoma are rare benign bone tumours, sometimes considered variations of the same pathologic process. However, they differ in location, incidence, age group, and size. The gold standard treatment is surgical excision for osteoblastoma and radiofrequency ablation for both. Minimally invasive techniques, including radiofrequency ablation, microwave ablations, cryoablation, ultrasound ablation, and laser ablation, are increasingly used. This meta-analysis aimed to review current treatments, focusing on minimally invasive methods versus traditional surgical excision. A data comparison of 17 original articles from the PubMed database (2014-2024) was conducted, examining treatment methods, patient numbers, success rates, pre/post-operative pain scores, and complication rates. New ablation methods achieve similar clinical results to traditional surgery for treating osteoid osteoma and osteoblastoma while minimizing invasiveness. Most procedures have technical success rates near 100%. Both invasive and non-invasive methods significantly reduce preoperative pain. Classical surgery has higher minor complication rates compared to minimally invasive treatments. Among ablation techniques, magnetic resonance guided focused ultrasound surgery is the least invasive, avoiding radiation and antibiotic-related complications. However, in ablation methods caution is needed to prevent thermal damage to nearby joints and nerves. Protective methods, such as skin protection, hydrodissection, gas dissection, and intraoperative neurostimulation, are recommended. New ablation methods provide less invasive alternatives to surgery, with high clinical and technical success rates and lower complication rates. Among these, magnetic resonance guided focused ultrasound surgery is the least invasive and most promising, though more clinical data is needed due to its recent development.

The use of Intracardiac Echocardiography in Catheter Ablation of Atrial Fibrillation.

Intracardiac echocardiography (ICE) provides real-time, fluoroless imaging of cardiac structures, allowing optimal catheter positioning and energy delivery during ablation procedures. This review summarizes the use of ICE in catheter ablation of atrial fibrillation (AF). Growing evidence suggests that the use of ICE improves procedural safety and facilitates radiofrequency and cryoballoon AF ablation. ICE-guided catheter ablation is associated with reduced procedural duration and fluoroscopy use. Recent studies have examined the role of ICE in guiding novel ablation techniques, such as pulsed field ablation. Finally, the use of ICE allows for early detection and timely management of potentially serious procedural complications. Intracardiac echocardiography offers significant advantages during AF ablation procedures and its use should be encouraged to improve procedural safety and efficacy.

Spanish catheter ablation registry. 23rd official report of the Heart Rhythm Association of the Spanish Society of Cardiology (2023)

Introduction and objectivesWe report the results of the 2023 Spanish catheter ablation registry. MethodsProcedural data were collected and incorporated into the REDCap platform by all participating centers through a specific form. ResultsThere were 104 participating centers in 2023 compared with 103 in 2022. In 2023, the total number of ablation procedures was 26 207, indicating a stabilization of the increase observed in 2022 following the pandemic. The increase was mainly due to procedures for atrial fibrillation (AF), with a total of 9942 ablations, representing 38% of all substrates. Notably, pulse-field ablation represented 10.3% of all AF ablation procedures, leading single-shot ablation strategies to outnumber point-by-point AF ablation for the first time in the history of the registry. Cavotricuspid isthmus ablation remained the second most targeted substrate (19% of all substrates, n=5067). The overall acute success rate remained high (97%), with a downward trend in the complication rate (1.6% vs 1.8% in 2022) and mortality rate (0.03%; n=7). Compared with 2022, there was a significant increase in procedures performed using electro-anatomical mapping and zero-fluoroscopy techniques for cavotricuspid isthmus ablation (52% vs 26%), AV node re-entrant tachycardia (48% vs 34%), and accessory pathways (62% vs 22%). We registered 466 ablations in pediatric patients. ConclusionsThe data indicate a stabilization in the post-pandemic increase in ablation procedures, with an absolute and relative increase in AF as the predominant substrate. Success rates remained stable with a modest reduction in complication and mortality rates.

Distribution characteristics of Purkinje fibres in the canine left ventricle.

Purkinje-related ventricular arrhythmias have been increasingly reported, and with the development of catheter ablation techniques, intervention for Purkinje-related arrhythmias has been shown to be effective. The characteristics of Purkinje fibres orientation in the 12 canine left ventricles were observed at a gross level by staining the endocardium with Lugol's solution. Purkinje fibres were observed microscopically by HE, Masson's, PAS glycogen, and Cx40 immunohistochemical staining. Staining was successful, and the transverse orientation characteristics of Purkinje fibres were observed by Lugol's staining, and the longitudinal distribution was observed microscopically. The distribution of Purkinje fibres in the canine left ventricle is 'graded', 'layered', and 'networked', which can guide catheter ablation of Purkinje-related ventricular arrhythmia.

Graphene oxide nanosheets decorated with Gold-Silver core-shell using pulsed laser ablation technique

Graphene oxide nanosheets decorated with Gold-Silver core-shell using pulsed laser ablation technique

Investigation of Thermophysical Properties of CuFeS2 Nanoparticles Prepared by Pulsed Laser Ablation Technique.

Investigation of Thermophysical Properties of CuFeS2 Nanoparticles Prepared by Pulsed Laser Ablation Technique.

Random laser ablated tags for anticounterfeiting purposes and towards physically unclonable functions

Anticounterfeiting tags affixed to products offer a practical solution to combat counterfeiting. To be effective, these tags must be economical, capable of ultrafast production, mass-producible, easy to authenticate, and automatable. We present a universal laser ablation technique that rapidly generates intrinsic, randomly distributed craters (in under a second) on laser-sensitive materials using a nanosecond pulsed infrared laser. The laser and scanning line parameters are balanced to produce randomly distributed craters. The tag patterns demonstrate high randomness, which is analyzed using pattern recognition algorithms and root mean square error deviation. The optical image information of the tag is digitized with a fixed bit uniformity of 0.5 without employing any debiasing algorithm. The efficacy of tags for anticounterfeiting is presented by securing the challenge associated with each tag. Statistical NIST tests are successfully performed on responses generated from both single and multiple tags, demonstrating the true randomness of the sequence of binary digits. The single(multiple) tag(s) achieved an actual encoding capacity of approximately 10391 (10518) and a low false rate (both positive and negative) on the order of 10−58 (10−50). Our findings introduce a laser-based method for anticounterfeiting tag generation, allowing for ultrafast and straightforward product processing with minimal fabrication and tag cost.

Catheter Ablation of Atrial Fibrillation in Patients with Heart Failure: Focus on the Latest Clinical Evidence.

Atrial fibrillation and heart failure are two common cardiovascular conditions that frequently coexist, and it has been widely demonstrated that in patients with chronic heart failure, atrial fibrillation is associated with a significant increase in the risk of all-cause death and all-cause hospitalization. Nevertheless, there is no unanimous consensus in the literature on how to approach this category of patients and which therapeutic strategy (rhythm control or frequency control) is the most favorable in terms of prognosis; moreover, there is still a lack of data comparing the different ablative techniques of atrial fibrillation in terms of efficacy, and many of the current trials do not consider current ablative techniques such as high-power short-duration ablation index protocol for radiofrequency pulmonary vein isolation. Eventually, while several RCTs have widely proved that in patients with heart failure with reduced ejection fraction, ablation of atrial fibrillation is superior to medical therapy alone, there is no consensus regarding those with preserved ejection fraction. For these reasons, in this review, we aim to summarize the main updated evidence guiding clinical decision in this complex scenario, with a special focus on the most recent trials and the latest meta-analyses that examined the role of catheter ablation (CA) in rhythm control in patients with AF and HF.

Regeneration of Antifog Performance of Laser-Induced Copper-Based Micro-Nano Structured Surfaces by Rapid Thermal Treatment.

In this investigation, the laser marker ablation technique was employed on Cu-coated glass to fabricate micro-nanostructured antifog glass. The resulting surfaces exhibited a quasi-periodic micron hillock-hollow structure with dispersed nanoparticles distributed throughout, which played a role in the antifog property and superhydrophilicity. However, airborne organic pollutant deposition degraded the superhydrophilicity of ablated glass surfaces and, therefore, their antifog performance, which cannot be circumvented. Conventionally, furnace annealing for at least 1 h was used to decompose the organic pollutants and restore the superhydrophilicity, limiting the throughput and application scenario. Remarkably, the rapid regeneration of this property was achieved through either a 5 min rapid thermal treatment at 400 °C or a 1 s flame treatment. These are interventions that are hitherto unreported. Such short and simple treatment methods underscore the potential of laser-ablated glass for diverse practical applications.

Mesenchymal Tumor Management: Integrating Surgical and Non-Surgical Strategies in Different Clinical Scenarios.

Mesenchymal tumors originate from mesenchymal cells and can be either benign or malignant, such as bone, soft tissue, and visceral sarcomas. Surgery is a cornerstone treatment in the management of mesenchymal tumors, often requiring complex procedures performed in high-volume referral centers. However, the COVID-19 pandemic has highlighted this need for alternative non-surgical approaches due to limited access to surgical resources. This review explores the role of non-surgical treatments in different clinical scenarios: for improving surgical outcomes, as a bridge to surgery, as better alternatives to surgery, and for non-curative treatment when surgery is not feasible. We discuss the effectiveness of active surveillance, cryoablation, high-intensity focused ultrasound, and other ablative techniques in managing these tumors. Additionally, we examine the use of tyrosine kinase inhibitors in gastrointestinal stromal tumors and hypofractionated radiotherapy in soft tissue sarcomas. The Sarculator tool is highlighted for its role in stratifying high-risk sarcoma patients and personalizing treatment plans. While surgery remains the mainstay of treatment, integrating advanced non-surgical strategies can enhance therapeutic possibilities and patient care, especially in specific clinical settings with limitations. A multidisciplinary approach in referral centers is vital to determine the optimal treatment course for each patient.

Basivertebral nerve ablation technique

Chronic low back pain represents a leading cause of global disability, but can often be complex in etiology, with multiple pain generators contributing to patient discomfort. Anterior column low back pain involves the vertebral bodies and discs, with the vertebral body endplates now known to be a significant pain generator. Vertebrogenic low back pain secondary to irritation of the basivertebral nerve presents as axial discomfort, worse with forward flexion, and with concomitant Type I or II Modic changes on MRI. Minimally invasive basivertebral nerve radiofrequency ablation has emerged as an effective intervention for managing anterior column back pain. In this article, the authors present a comprehensive approach to identifying and treating vertebrogenic low back pain through image guided basivertebral nerve ablation. We outline the patient presentation and diagnostic workup, followed by a detailed procedural guide including equipment requirements, technique execution, and potential technical challenges and complications.

Cryo-Nanocatalyst Enhances Therapeutic Efficacy of Cryo-Immunotherapy through Necroptosis and Local Delivery of Programmed Death-Ligand 1 Inhibitors.

Combining cryoablation and immunotherapy presents a promising approach to revert immunosuppressive responses to solid tumors. However, challenges such as postablated residual tumors and insufficient immune activity contribute to recurrence after cryo-immunotherapy. Herein, we investigated metallic supra-structured cryo-nanocatalyst (MSCN), which features numerous ice nucleation sites and interspace loading of therapeutic agents. MSCN elevates the freezing point and enhances ice nucleation, facilitating effective ice formation during cryotreatment. MSCN-loaded tumor cells showed a 2-fold increase in cryo-cytotoxicity and undergo osmotic-related cell damage, primarily necroptosis rather than other regulated cell death mechanisms. In prostate cancer models, RNA sequencing reveals that MSCN-cryoablation promoted antitumor inflammatory pathways, including necroptosis, compared to cryoablation alone. Additionally, following programmed death-ligand 1 (PD-L1) upregulation postcryoablation, synergistic effects with PD-L1 blockade were confirmed. Given the interspace of MSCN for aPD-L1 loading, we compared the intratumoral delivery of PD-L1 blockade against systemic injection. Enhanced necrosis and necroptosis from MSCN-cryoablation and PD-L1 blockade effectively eradicated tumors and triggered antitumor and memory immune responses locally and systemically. Lastly, a spatial landscape of tumor-infiltrating immune cells was analyzed to gain insight into heterogeneous tumor responses, leading to the limitations of conventional focal ablation techniques. Our findings highlight the potential of advanced cryo-immunotherapy using cryo-nanocatalysis to promote ice formation and necroptosis, stimulating antitumor immunogenic responses.

Efficacy and Safety of Cryoablation in Barrett's Esophagus and Comparison with Radiofrequency Ablation: A Meta-Analysis.

The mainstay approach in endoscopic eradication therapy (EET) for dysplastic Barrett's esophagus (BE) includes the endoscopic resection of visible lesions, accompanied by ablation of the residual metaplastic epithelium. Cryoablation therapy is one such emerging ablation technique in this field. This systematic review with a meta-analysis aims to accumulate pooled data on cryoablation performance in the treatment of patients with BE and to compare this technique to the standard of care radiofrequency ablation (RFA). The MEDLINE, Cochrane, and Scopus databases were searched until June 2024 for studies evaluating BE management using cryoablation for cumulative results. The primary outcome was the complete eradication of dysplasia (CED) and intestinal metaplasia (CEIM) in BE compared to RFA, while secondary outcomes included the respective pooled rates using cryoablation, recurrence, and adverse events, with a separate analysis for strictures. The meta-analyses were based on a random-effects model, and the results were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup analyses by type of cryoablation were also performed. Twenty-three studies (1604 patients) were finally included, four of which were comparative. CED and CEIM did not differ significantly between cryoablation and RFA [OR= 0.95 (95%CI: 0.50-1.81) and OR = 0.57 (95%CI: 0.20-1.63), respectively)]. The pooled rates of CED, CEIM, and recurrence after cryoablation were 84.2% (95%CI: 79.1-89.3), 64.1% (95%CI: 49.2-79.0), and 8.3% (95%CI: 4.7-11.9), accompanied by high rates of heterogeneity. Adverse events were noted in 14.5% (95%CI: 9.9-19.2) of cases, and 6.5% (95%CI: 4.1-9.0) developed strictures. In the subgroup analysis, the cryoballoon achieved a reduction in heterogeneity in CED, adverse events, and stricture formation, whereas spray catheters provided homogenous results in terms of recurrence. Cryoablation provides equal outcomes compared to RFA in the treatment of patients with BE, with the cryoballoon achieving relatively homogenous rates of CED and adverse events.

Highly Sensitive and Flexible Capacitive Pressure Sensors Combined with Porous Structure and Hole Array Using Sacrificial Templates and Laser Ablation.

Flexible, wearable pressure sensors offer numerous benefits, including superior sensing capabilities, a lightweight and compact design, and exceptional conformal properties, making them highly sought after in various applications including medical monitoring, human-computer interactions, and electronic skins. Because of their excellent characteristics, such as simple fabrication, low power consumption, and short response time, capacitive pressure sensors have received widespread attention. As a flexible polymer material, polydimethylsiloxane (PDMS) is widely used in the preparation of dielectric layers for capacitive pressure sensors. The Young's modulus of the flexible polymer can be effectively decreased through the synergistic application of sacrificial template and laser ablation techniques, thereby improving the functionality of capacitive pressure sensors. In this study, a novel sensor was introduced. Its dielectric layer was developed through a series of processes, including the use of a sacrificial template method using NaCl microparticles and subsequent CO2 laser ablation. This porous PDMS dielectric layer, featuring an array of holes, was then sandwiched between two flexible electrodes to create a capacitive pressure sensor. The sensor demonstrates a sensitivity of 0.694 kPa-1 within the pressure range of 0-1 kPa and can effectively detect pressures ranging from 3 Pa to 200 kPa. The sensor demonstrates stability for up to 500 cycles, with a rapid response time of 96 ms and a recovery time of 118 ms, coupled with a low hysteresis of 6.8%. Furthermore, our testing indicates that the sensor possesses limitless potential for use in detecting human physiological activities and delivering signals.

Endovenous thermal ablation mid-term outcomes for the treatment of large diameter incompetent great saphenous veins.

The aim of this study was to assess the efficacy and safety of endovenous thermal ablation (EVTA) in treating large diameter, ≥12mm, incompetent great saphenous vein (GSV) in comparison to smaller ones. A retrospective comparative study was undertaken including 196 patients (205 limbs) undergoing EVTA. According to maximum GSV diameter patients were divided into two groups (group A <12mm, group B ≥12mm). Primary outcome was anatomic success defined as absence of reflux of GSV. Secondary outcomes were complications, postoperative pain using the 10-cm Visual Analog Scale (VAS) and improvement of Venous Clinical Severity Score (VCSS) and Chronic Venous Insufficiency Quality-of-Life Questionnaire (CΙVIQ-20) scores assessed at 7- days, 1month, 12months and 24months postoperatively. 118 patients with GSV diameter <12mm (group A) and 87 with GSV diameter ≥12mm (group B) were included. Patients' demographics, CEAP classification and length of ablated vein did not differ between the groups. Preoperative VCSS and VAS pain score were significant greater in group B (6.03 vs 6.94, p = .04 and 5.21 vs 5.77, p = .032, respectively). No differences in adverse events were observed post-operatively among groups. GSV occlusion rate at 1month was 98.3% (SE 1.3%) in group A and 96.5 % (2.2%) in group B (p = .3), at 12months 95.7% (SE 2%) and 94.2% (SE 2.8%) (p = .5), and at 24months 94% (SE 2.4%) and 93.1% (SE 3%) (p = .4) respectively. Both groups experienced significant and similar improvement in their VCSSs and CIVIQ scores postoperatively. In a subgroup analysis among different EVTA and GSV >12mm, 1470nm endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) showed comparable results in terms of occlusion rates, complications, VCSS and CIVIQ scores. Endovenous thermal ablation techniques are efective and safe in the treatment of GSV incompetence regardless the diameter of the GSV. Both 1470nm EVLA and RFA techniques performed similar outcomes.