Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) are two minimally invasive procedures for treating varicose veins. Both techniques apply heat (from different sources) to the inside of the vein to make it collapse and close off. This article explains the similarities and differences between the two approaches. 

Similarities between EVLA and RFA

Endothermal ablation techniques 

EVLA and RFA are both types of endothermal ablation, which means that they apply heat to the inside of the vein so that it collapses and closes off. This approach is minimally invasive and performed under local anaesthetic as a walk-in-walk-out procedure with minimal recovery time. Both treatments are performed in the clinic and there is no need for a hospital stay. 

Pre-procedure ultrasound

Both techniques require an ultrasound of the affected leg(s) to identify the location of the veins to be treated. Ultrasound is also used during the procedures to guide the surgeon and ensure precision. 

Post-procedure dressing and compression

Once the EVLA or RFA procedure has been completed, the affected leg is dressed with a bandage and a compression stocking to help manage any discomfort and reduce the risk of procedure-related complications.¹

Treating varicose veins with laser ablation 

For this procedure, a thin catheter is inserted into the affected vein. The catheter contains a laser that delivers heat to the vein walls, causing them to collapse. The body then naturally absorbs the dead tissue, and blood is redirected to other healthy veins. 

EVLA and RFA produce similar results, but EVLA can cause significantly more bruising and discomfort.² It is also a relatively new treatment, so there is limited evidence for long-term effectiveness. 

Treating varicose veins with radiofrequency ablation

RFA also uses a catheter, but it emits ratio waves rather than laser and leaves only a tiny amount of scarring, bruising or swelling. This well-established procedure is highly effective, with a 97-100% success rate and a lower risk for vein perforation than EVLA. 

RFA can also be used alongside ultrasound-guided foam sclerotherapy (UGFS) to treat more troublesome superficial varicose veins. The National Institute for Health and Care Excellence (NICE) recommends using UGFS when endothermal ablation is unsuitable.

Venous experts believe RFA provides better patient satisfaction than EVLA

In a 2015 survey administered to 798 practising veins specialists by the American Venous Forum (AVF), participants were asked to record which varicose vein treatment they associated with better patient outcomes and satisfaction. 57% of participants named RFA as being superior, 24% identified EVLA, and the remaining 19% of respondents recorded higher patient satisfaction with other treatments such as foam sclerotherapy or stated that there was no difference. ³

Conclusion

EVLA and RFA are both effective procedures for treating varicose veins. RFA has some advantages over EVLA, namely a greater body of evidence for its efficacy, fewer risks and side effects and perceived better patient outcomes in the view of venous experts. 

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References

  1. van den Bos, R.R., Proebstle, T.M. The state of the art of endothermal ablation. Lasers Med Sci 29, 387–392 (2014). https://doi.org/10.1007/s10103-013-1448-5
  2. Rasmussen LH, Lawaetz M, Bjoern L, Vennits B, Blemings A, Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011 Aug;98(8):1079-87. doi: 10.1002/bjs.7555. PMID: 21725957.
  3. Aziz F, Diaz J, Blebea J, Lurie F; American Venous Forum. Practice patterns of endovenous ablation therapy for the treatment of venous reflux disease. J Vasc Surg Venous Lymphat Disord. 2017 Jan;5(1):75-81.e1. doi: 10.1016/j.jvsv.2016.08.006. PMID: 27987615. 

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