Effects of Endovenous Radiofrequency Ablation on Right Ventricular Functions and Pulmonary Hemodynamics in Superficial Venous Insufficiency

Background: Although chronic venous insufficiency is often treated as a localized problem, it is a systemic condition that can negatively affect cardiac hemodynamics. This study investigates the associated effects of eliminating the pathologic venous reservoir on right ventricular (RV) functions, systolic pulmonary artery pressure (sPAP), and inferior vena cava (IVC) diameter in patients undergoing endovenous radiofrequency ablation (RFA) for severe great saphenous vein (GSV) insufficiency. Methods: This retrospective observational study included 154 patients who presented between September 2023 and May 2025 with GSV insufficiency (CEAP C3-C4b) and underwent endovenous RFA. Patients with major cardiopulmonary diseases were strictly excluded. Preoperative and 6-month postoperative transthoracic echocardiography records were analyzed to evaluate RV diastolic diameter, tricuspid annular plane systolic excursion (TAPSE), sPAP, the TAPSE/sPAP ratio, and IVC diameter. Results: At 6 months post-RFA, compared to preoperative values, a significant decrease was detected in the mean sPAP (14.7 ± 2.5 vs. 11.8 ± 1.8 mmHg, p < 0.001) and IVC diameter (2.1 ± 0.2 vs. 1.9 ± 0.2 cm, p < 0.001). Furthermore, significant improvements were observed in TAPSE (20.0 ± 2.0 vs. 21.5 ± 1.8 mm, p < 0.001) and the TAPSE/sPAP ratio (1.36 ± 0.15 vs. 1.82 ± 0.18 mm/mmHg, p < 0.001). Conclusions: Endovenous RFA is associated with favorable changes in right heart parameters. Eliminating pathologic extremity blood pooling may optimize venous return kinetics and subclinically improve right ventricular–pulmonary arterial coupling.