{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:16:05Z","timestamp":1784556965694,"version":"3.55.0"},"reference-count":33,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Truncal vein insufficiency can be treated with endovenous thermal ablation (EVTA), non-thermal non-tumescent techniques, ultrasound-guided foam or microfoam sclerotherapy, and high ligation with stripping. However, the optimal management of large-diameter truncal veins remains unclear. This structured review summarizes treatment outcomes in large-diameter incompetent truncal veins and compares available modalities according to vein diameter, anatomical success, recurrence, reintervention, and complications. A PubMed\/MEDLINE search was performed for studies published between January 2000 and June 2026. Studies were eligible if they specifically evaluated incompetent great saphenous veins, small saphenous veins, or accessory saphenous veins described as large-diameter, large-caliber, very large, enlarged, or wide-diameter truncal veins. Twenty-three primary studies met the inclusion criteria. Definitions of large-diameter veins varied widely, ranging from &gt;8 mm to &gt;20 mm. EVTA represented the largest evidence base and generally showed high anatomical success, with most studies reporting occlusion, recurrence-free, or recanalization-free rates above 90%. Foam-based treatment, cyanoacrylate closure, and mechanochemical ablation were supported by fewer large-vein-specific studies, and durability in larger veins remains less certain. High ligation and stripping showed low recurrence or residual stump rates in selected comparative studies, but outcome definitions differed from endovenous occlusion endpoints. Current evidence supports individualized treatment selection based on vein diameter, anatomy, tortuosity, reflux pattern, and expected durability. Dedicated randomized trials using standardized diameter definitions and outcome reporting are needed.<\/jats:p>","DOI":"10.3390\/jcm15145686","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:18:31Z","timestamp":1784553511000},"page":"5686","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment of Large-Diameter Truncal Veins: A Structured Review of Contemporary Endovenous and Surgical Modalities"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5097-6325","authenticated-orcid":false,"given":"Abhay","family":"Setia","sequence":"first","affiliation":[{"name":"Department of Vascular Surgery, DIAK Klinikum Landkreis Schwaebisch Hall, 74523 Schwaebisch Hall, Germany"},{"name":"Department of Vascular Medicine, Division of Vascular and Endovascular Surgery, Klinikum Darmstadt, 64283 Darmstadt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claus-Georg","family":"Schmedt","sequence":"additional","affiliation":[{"name":"Department of Vascular Surgery, DIAK Klinikum Landkreis Schwaebisch Hall, 74523 Schwaebisch Hall, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.ejvs.2021.12.024","article-title":"European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs","volume":"63","author":"Kakkos","year":"2022","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"101681","DOI":"10.1016\/j.jvsv.2023.08.020","article-title":"A systematic review on ablation techniques for larger saphenous veins in patients with symptomatic superficial venous disease","volume":"12","author":"Athavale","year":"2024","journal-title":"J. Vasc. Surg. Venous Lymphat. Disord."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1177\/1358863X231183997","article-title":"Endovenous thermal ablation in the treatment of large great saphenous veins of diameters > 12 mm: A systematic review meta-analysis and meta-regression","volume":"28","author":"Bontinis","year":"2023","journal-title":"Vasc. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1111\/ans.12672","article-title":"Role of endovenous laser therapy in large and very large diameter great saphenous veins","volume":"86","author":"Florescu","year":"2016","journal-title":"ANZ J. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1177\/1538574409345026","article-title":"Effect of saphenous vein diameter on closure rate with ClosureFAST radiofrequency catheter","volume":"43","author":"Calcagno","year":"2009","journal-title":"Vasc. Endovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1016\/j.avsg.2011.02.031","article-title":"Expanding the role of endovenous laser therapy: Results in large diameter saphenous, small saphenous, and anterior accessory veins","volume":"25","author":"Chaar","year":"2011","journal-title":"Ann. Vasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1016\/j.avsg.2015.03.063","article-title":"A comparison of 1470-nm endovenous laser ablation and radiofrequency ablation in saphenous veins larger than 10 mm in diameter","volume":"29","author":"Mese","year":"2015","journal-title":"Ann. Vasc. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1016\/j.jvir.2015.04.015","article-title":"Efficacy and safety of endovenous laser ablation in very large and tortuous great saphenous veins","volume":"26","author":"Atasoy","year":"2015","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1177\/0268355514555546","article-title":"Endovenous laser ablation in patients with wide diameter of the proximal segment of the great saphenous vein: Comparison of methods","volume":"30","author":"Starodubtsev","year":"2015","journal-title":"Phlebology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jvsv.2015.07.007","article-title":"Radiofrequency ablation or stripping of large-diameter incompetent great saphenous varicose veins with C2 or C3 disease","volume":"4","author":"Shaidakov","year":"2016","journal-title":"J. Vasc. Surg. Venous Lymphat. Disord."},{"key":"ref_11","first-page":"810","article-title":"Prospective study of safety and effectiveness in the use of radiofrequency ablation for incompetent great saphenous vein according to diameter","volume":"5","author":"Fernandez","year":"2017","journal-title":"Phlebology"},{"key":"ref_12","first-page":"368","article-title":"Endovenous laser ablation in patients with severe primary chronic venous insufficiency and large-diameter great saphenous veins","volume":"34","author":"Starodubtsev","year":"2017","journal-title":"Phlebology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1177\/0268355517734480","article-title":"A description of the \u201csmile sign\u201d and multi-pass technique for endovenous laser ablation of large diameter great saphenous veins","volume":"33","author":"Dabbs","year":"2018","journal-title":"Phlebology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"514","DOI":"10.3400\/avd.oa.18-00169","article-title":"Endovenous laser ablation combined with stripping technique for large saphenous varicose veins: The selection of operation technique","volume":"12","author":"Nakashima","year":"2019","journal-title":"Ann. Vasc. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"136","DOI":"10.4103\/ejs.ejs_150_18","article-title":"The 1470 radial endovenous laser ablation of the great saphenous vein larger than 12 mm: Is it a good option? A single-center experience","volume":"38","author":"Elboushi","year":"2019","journal-title":"Egypt. J. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"313","DOI":"10.4174\/astr.2019.96.6.313","article-title":"Outcome of ClosureFAST radiofrequency ablation for large-diameter incompetent great saphenous vein","volume":"96","author":"Woo","year":"2019","journal-title":"Ann. Surg. Treat. Res."},{"key":"ref_17","first-page":"94","article-title":"What is the optimal treatment technique for great saphenous vein diameter of \u226510 mm? Comparison of five different approaches","volume":"121","author":"Kubat","year":"2021","journal-title":"Acta Chir. Belg."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"379","DOI":"10.2147\/VHRM.S313282","article-title":"Radiofrequency ablation for axial reflux associated with foam sclerotherapy for varicosities in one-step approach: A prospective cohort study comprising large diameters saphenous veins","volume":"17","author":"Porto","year":"2021","journal-title":"Vasc. Health Risk Manag."},{"key":"ref_19","first-page":"135","article-title":"Efficiency of radio frequency ablation v. saphena magna large diameter in outpatient conditions","volume":"2","author":"Sviderskyi","year":"2022","journal-title":"Zdobutky Klin. I Eksp. Medytsyny"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"104036","DOI":"10.1016\/j.amsu.2022.104036","article-title":"Non-randomized comparative study of three methods for great saphenous vein varicose veins with diameter of 10 mm or more","volume":"80","author":"Baram","year":"2022","journal-title":"Ann. Med. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1016\/j.jvsv.2023.03.014","article-title":"Early results following comparison of radiofrequency and microfoam ablation of large-diameter truncal veins demonstrate high closure rates and symptomatic relief","volume":"11","author":"Chin","year":"2023","journal-title":"J. Vasc. Surg. Venous Lymphat. Disord."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.avsg.2023.12.076","article-title":"Comparison of radiofrequency ablation and cyanoacrylate closure for large-diameter great saphenous vein insufficiency","volume":"103","author":"Kavala","year":"2024","journal-title":"Ann. Vasc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1177\/02683555241272971","article-title":"Endovenous thermal ablation mid-term outcomes for the treatment of large-diameter incompetent great saphenous veins","volume":"40","author":"Karathanos","year":"2025","journal-title":"Phlebology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.avsg.2025.09.037","article-title":"Recanalization in large-diameter saphenous veins after thermal ablation: A retrospective review of Vascular Quality Initiative data","volume":"123","author":"Pisharody","year":"2026","journal-title":"Ann. Vasc. Surg."},{"key":"ref_25","first-page":"1386","article-title":"Microfoam ultrasound-guided sclerotherapy treatment for varicose veins in a subgroup with diameters at the junction of 10 mm or greater compared with a subgroup of less than 10 mm","volume":"30","author":"Barrett","year":"2004","journal-title":"Dermatol. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"101935","DOI":"10.1016\/j.jvsv.2024.101935","article-title":"Vein diameter, obesity, and rates of recanalization after mechanochemical ablation","volume":"12","author":"Pisharody","year":"2024","journal-title":"J. Vasc. Surg. Venous Lymphat. Disord."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Setia, A., Dikic, S., Demhasaj, S., Schmitz-Rixen, T., Sroka, R., and Schmedt, C.-G. (2023). Prospects of endovenous laser ablation (EVLA) standardization\u2014Mid-term results of a four-zone dosimetry guiding tool for 1940 nm laser. J. Clin. Med., 12.","DOI":"10.3390\/jcm12134313"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1002\/lsm.23500","article-title":"Safety and efficacy of endovenous laser ablation (EVLA) using 1940 nm and radial emitting fiber: 3-year results of a prospective, non-randomized study and comparison with 1470 nm","volume":"54","author":"Setia","year":"2022","journal-title":"Lasers Surg. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"3473","DOI":"10.1007\/s10103-022-03609-w","article-title":"Endovenous laser ablation using laser systems emitting at wavelengths > 1900 nm: A systematic review","volume":"37","author":"Setia","year":"2022","journal-title":"Lasers Med. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Bukina, O.V., and Alekseev, D.N. (2026). Endovenous vacuum-assisted laser ablation (VALA) for the treatment of great saphenous vein aneurysm close to the junction (Type I). Phlebology, Online ahead of print.","DOI":"10.1177\/02683555261465465"},{"key":"ref_31","unstructured":"ClinicalTrials.gov (2026, July 10). Endovenous Vacuum-Assisted Laser Ablation (VALA) in the Treatment of Large Saphenous Veins (>15 mm); ClinicalTrials.gov Identifier: NCT06971068, Available online: https:\/\/clinicaltrials.gov\/study\/NCT06971068."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1016\/j.ejvs.2018.12.007","article-title":"Safety and effectiveness of endovenous thermal ablation for incompetent saphenous veins with an aneurysm close to the junction","volume":"58","author":"Hamann","year":"2019","journal-title":"Eur. J. Vasc. Endovasc. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1177\/02683555221149273","article-title":"Safety and effectiveness of indirect radiofrequency ablation (ClosureFAST) of incompetent great saphenous veins with type I aneurysms: Long-term results","volume":"38","author":"Schuller","year":"2023","journal-title":"Phlebology"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5686\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T13:24:39Z","timestamp":1784553879000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/14\/5686"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":33,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["jcm15145686"],"URL":"https:\/\/doi.org\/10.3390\/jcm15145686","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]}}}