Discussion of postoperative compression should distinguish anatomical success, early pain and long-term patient-important outcomes. A recent small RFA trial supports reconsidering the burden of compression. However, the information available for verification is insufficient to generalize “overnight compression” to all procedures, and it does not support patients independently discontinuing a prescribed regimen. This article does not indicate that Dr Liang has changed his care protocol.
Study findings
Taengsakul et al. enrolled 60 patients with C2–C4 disease, with 30 in each group. According to the Methods, the overnight group received elastic bandaging for 12–18 hours; the seven-day group wore above-knee class II compression stockings (23–32 mmHg) continuously for seven days. In each group, 13 patients also underwent phlebectomy through 1–3 incisions. The primary endpoint was duplex-confirmed closure of at least 90% of the treated length at 12 weeks, with a patent stump no longer than 2 cm. All 30 patients in each group met this endpoint, and all completed follow-up. [2]
The authors specified a noninferiority margin of 10 percentage points, but reported only p=1.000 for the primary endpoint and did not provide a confidence interval for the primary effect. Intention-to-treat (ITT) and per-protocol (PP) analysis sets were not explicitly identified. Although the authors concluded noninferiority, identical closure rates and this p value alone do not allow independent confirmation of that conclusion. The full text also assigns ecchymosis and phlebitis to opposite groups in its narrative and tables, and inconsistently labels a pain-assessment time point as day 14 or day 10. Those group assignments and time points are therefore not used here to support definite conclusions. [2]
The full text checked for this appraisal was the webpage uploaded by an author on 11 December 2024, rather than a separately verified publisher PDF. The article was published online in 2024 and in a 2025 issue; it should not be described as a new 2026 result. The study did not establish an advantage in pain or satisfaction and does not provide sufficient grounds to relax activity restrictions. [2]
Read alongside pain-focused evidence
COMETA randomized 206 patients to seven days of compression or no stockings, with pain during the first ten postoperative days as the primary outcome. Its abstract reports lower pain in the compression group on days 2–5, with improvement on some early days also seen among patients undergoing concomitant phlebectomy. [3] A trial with vein closure as its primary endpoint cannot fully answer the question of pain during recovery. Differences in combinations of procedures and assessment time points may affect comparability.
Guideline recommendation
Part II of the 2023 SVS/AVF/AVLS guidelines suggests at least one week of postoperative compression to reduce pain in patients undergoing thermal ablation of a saphenous vein, with or without concomitant phlebectomy. This is a weak recommendation based on moderate-quality evidence. [1] Its purpose and strength should be preserved in interpretation. “At least one week” should not be presented as a universal requirement across procedures or as a necessary condition for achieving closure.
What can the 2026 trial protocol add?
In March 2026, Yang et al. published a protocol for a multicenter randomized trial planning to enroll 600 patients with C2–C6 disease. It compares one, three and six months of compression after thermal ablation, focusing on quality of life and recurrence. [4] This is a protocol, without completed results that can establish treatment efficacy. It is also not a direct replication of the overnight-versus-seven-day comparison.
References
- 2023 SVS/AVF/AVLS clinical practice guidelines, Part II, recommendation 2.2.1 View source
- Taengsakul et al. Comparison of a compression for seven days or overnight after endovenous radiofrequency ablation of superficial vein. Vascular. 2025;33(6):1432–1440. First published online 10 December 2024. View source · Author-uploaded full text
- Bootun et al. COMETA Trial. Ann Surg. 2021;273(2):232–239. View source
- Yang et al. Effect of different durations of compression therapy on quality of life and recurrence after thermal ablation for varicose veins: a protocol. Front Med. 2026;13:1744286. View source