BackgroundChronic venous insufficiency (CVI) is a prevalent vascular disorder with significant morbidity. Minimally invasive endovenous therapies, including N-butyl cyanoacrylate (NBCA), endovenous laser ablation (EVLA), and radiofrequency ablation (RFA), are widely used, yet comparative mid-term data remain limited. This study aimed to compare these three modalities.MethodsWe retrospectively reviewed 210 patients (70 per group) treated for CVI with NBCA, EVLA, or RFA between January 2018 and June 2022. Inclusion criteria were symptomatic varicose veins classified as CEAP C2–C4b, GSV diameter >5.5 mm, and reflux >0.5 s. The primary endpoint was vein occlusion rate; secondary endpoints included procedure duration, post-procedural pain (VAS) at 6 hours, return to daily activities, complications, and changes in Venous Clinical Severity Score (VCSS). Follow-up was performed at 1 week, 6 months, 12 months, and annually thereafter.ResultsOcclusion rates were high across groups (EVLA 97.1%, RFA 97.1%, NBCA 96.2%; P = 0.595). NBCA had the shortest procedure time (11.9 ± 1.3 min), lowest pain scores (VAS 1.2 ± 0.9), and fastest return to activities (1.1 ± 0.3 days), whereas EVLA showed higher pain scores (VAS 3.3 ± 1.7) and longer recovery (1.7 ± 0.8 days). VCSS improved significantly in all groups at 12 months, with no differences at 24-36 months. Complication rates were low (13.3%), with one deep vein thrombosis in the EVLA group.ConclusionsNBCA, EVLA, and RFA provide effective mid-term occlusion and clinical improvement in CVI. NBCA offers shorter procedure time, lower pain, and faster recovery, while RFA ensures durable outcomes with good tolerance. EVLA remains effective with slightly longer recovery. Technique selection may be guided by clinical context and patient preference.