Abstract
To compare procedural and early postoperative pain after endovenous laser ablation (EVLA), EVLA with concomitant phlebectomy, and cyanoacrylate closure (VenaSeal). Consecutive patients undergoing EVLA, EVLA with phlebectomy, or cyanoacrylate closure between January 2024 and January 2025 were included. Pain was assessed using a numerical rating scale (NRS, 0-10) immediately after the procedure and at telephone follow-up 10-14 days postoperatively. Multivariable linear regression was used to adjust for baseline differences between groups. A total of 392 patients were analysed (EVLA: n=190; EVLA with phlebectomy: n=109; cyanoacrylate closure: n=93). Pain scores were low across all groups, both immediately after the procedure (mean NRS 1.52) and at follow-up (mean NRS 1.43), with no significant differences between treatment modalities before or after adjustment. Concomitant phlebectomy did not increase pain. Clinical outcomes and complication rates were comparable. EVLA, EVLA with phlebectomy, and cyanoacrylate closure are associated with an equally low pain burden. Pain should not be a decisive factor when selecting among established endovenous treatment modalities.