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Comparison of Endovenous Laser and Radiofrequency Ablation in Treating Varices in the Same Patient

Abstract
- Introduction: To compare endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in different legs in the same individual in patients with venous insufficiency.
- Methods: Sixty patients with bilateral saphenous vein insufficiency were included. EVLA or RFA was applied to one of the patient’s legs and RFA or EVLA to the other leg.
- Results: EVLA and RFA complications were hyperemia at 20.7% and 31.0%, ecchymosis at 31.0% and 51.7% and edema at 27.6% and 65.5%, respectively. The rate of recanalization was 6.8% in the RFA group. No recanalization was observed in EVLA group. The level of patients satisfied with EVLA was 51.7%, compared to 31.0% for RFA, while 17.2% of patients were satisfied with both procedures. Times to return to daily activity were 0.9 days in the EVLA group and 1.3 days in the RFA group.
- Conclusion: EVLA procedure may be superior to RFA in certain respects.
- Keywords: Varicose veins; Endovascular laser ablation; Radiofrequency ablation.

 

Introduction
Ligation and stripping was for years the most frequently employed therapeutic option in the treatment of great saphenous vein insufficiency. However, in association with technological advances, there has been continual research into treating the disease using endovenous methods. Research into sclerosing the venous wall using thermal methods in particular has recorded considerable progress, and in 2001 Navarro et al published the first application of thermal endovenous ablation using an 810 nm diode laser.1 Since then, there has been increasing progress in laser technology, and numerous studies have been performed using different wavelengths and types of laser.2-7 The Food and Drug Administration (FDA)-approved lasers today are 810, 940, 980 and 1470 nm diode lasers and 1319 and 1320 nm neodymium-doped yttrium aluminium garnet (Nd:YAG) lasers. In parallel to advances in laser technology, studies began being performed concerning thermal ablation of the saphenous vein using radiofrequency energy, and permission for the use of radiofrequency energy in endovenous ablation was granted by the FDA in 1999. In 2002, Weiss and Weiss reported the first patients receiving thermal ablation using radiofrequency energy.8 Numerous studies using radiofrequency ablation (RFA) were subsequently published.9-11 Studies comparing endovenous laser ablation (EVLA) and RFA then began being published. These studies generally reported equal success between EVLA and RFA, albeit with fewer side-effects and greater patient satisfaction with RFA.12,13 However, all these studies compared laser energy at low wavelengths (810, 940 and 980 nm) with radiofrequency. However, high wavelength laser energy and radial fiber have been shown to produce better patient satisfaction and fewer side-effects compared to low wavelength laser energy and bare fiber.14 There are no clinical studies in the literature comparing laser energy at a wavelength of 1470 or more with RFA. We therefore planned this study in order to assess patients receiving EVLA with laser energy at a wavelength of 1470 nm and radial fiber and patients receiving RFA in terms of procedure success, complications and patient satisfaction. In order to eliminate patient-related variables, EVLA was applied to one leg of patients with bilateral saphenous vein insufficiency and RFA to the other leg.