Comparing the Success Rate and Side Effects of Endovenous Laser Ablation and Radiofrequency Ablation to Treat Varicose Veins in the Lower Limbs: A Randomized Clinical Trial Comparing EVLA With RFA for Varicosis
Journal of Lasers in Medical Sciences,
Vol. 11 No. Supplement (2020),
30 December 2020
Introduction: Varicosis is a condition affecting the superficial venous system of the lower limbs. Endovenous laser ablation (EVLA) is a minimally invasive method that uses different frequencies of laser for treatment. Radiofrequency (RF) has also been effectively used for vein ablation through thermal mechanisms. This study compares the success rate and side effects of EVLA and RF to treat varicose veins in the lower limbs within 12 months.
Methods: In this two-arm, randomized controlled, single-blind study, 1090 patients with lower limb varicosis proven by Doppler ultrasonography (DUS) were randomly placed into one of the two groups: EVLA and RF ablation. In the EVLA group, we used a 980-nm diode laser in a pulsed mode, and in the RF group, a 7-cm ClosureFast (Covidien, USA) catheter with an RF generator. We assessed pain during the operation and 8 and 24 hours after the surgery by the numerical rating scale (NRS). The patients were followed up on day 7, then 3, 6, and 12 months postoperatively. The presence or absence of pain and then the severity of pain (according to NRS), the recurrence rate, complications, and the length of the procedure were compared.
Results: There was no significant difference between the two groups in the patients’ characteristics, major adverse events, and pain severity during the procedure and 8 and 24 hours after the surgery. According to NRS, the mean chronic pain severity in the EVLA group was 3.99± 0.754 versus 4.50± 0.657 in the RF group, and the difference was not significant. The length of operation and the recurrence rate 12 months after the procedure were not significantly different.
Conclusion: The results of our study further establish the efficacy of EVLT and RF ablation for lower limb varicosis treatment without any significant difference in the clinical outcomes and complications during 12-months follow-up.
- Endovenous Laser Ablation, EVLA, Radiofrequency Ablation, RF, varicosis
How to Cite
Bartholomew JR, King T, Sahgal A, Vidimos AT. Varicose veins: newer, better treatments available. Cleve Clin J Med. 2005;72(4):312-8. doi: 10.3949/ccjm.72.4.312.
Robertson L, Evans C, Fowkes FG. Epidemiology of chronic venous disease. Phlebology. 2008;23(3):103-111. doi: 10.1258/phleb.2007.007061.
Labas P, Cambal M. Profuse bleeding in patients with chronic venous insufficiency. Int Angiol. 2007;26(1):64-66.
Marchiori A, Mosena L, Prandoni P. Superficial vein thrombosis: risk factors, diagnosis, and treatment. Semin Thromb Hemost. 2006;32(7):737-743. doi: 10.1055/s-2006-951459.
Lurie F, Passman M, Meisner M, Dalsing M, Masuda E, Welch H , et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020;8(3):342-52. doi: 10.1016/j.jvsv.2019.12.075.
Dwerryhouse S, Davies B, Harradine K, Earnshaw JJ. Stripping the long saphenous vein reduces the rate of reoperation for recurrent varicose veins: five-year results of a randomized trial. J Vasc Surg. 1999;29(4):589-592. doi: 10.1016/s0741-5214(99)70302-2.
Teo TK, Tay KH, Lin SE, Tan SG, Lo RH, Taneja M, et al. Endovenous laser therapy in the treatment of lower-limb venous ulcers. J Vasc Interv Radiol. 2010;21(5):657-662. doi: 10.1016/j.jvir.2010.01.029.
Luebke T , Brunkwall J. Systematic review and meta-analysis of endovenous radiofrequency obliteration, endovenous laser therapy, and foam sclerotherapy for primary varicosis. J Cardiovasc Surg (Torino). 2008;49(2):213-33.
Enzler MA, van den Bos RR. A new gold standard for varicose vein treatment? Eur J Vasc Endovasc Surg. 2010;39(1):97-98. doi: 10.1016/j.ejvs.2009.09.008.
Navarro L, Min RJ, Bone C. Endovenous laser: a new minimally invasive method of treatment for varicose veins—preliminary observations using an 810 nm diode laser. Dermatol Surg. 2001;27(2):117-122. doi: 10.1046/j.1524-4725.2001.00134.x.
Luebke T , Gawenda M, Heckenkamp J, Brunkwall J. Meta-analysis of endovenous radiofrequency obliteration of the great saphenous vein in primary varicosis. J Endovasc Ther. 2008;15(2):213-23. doi: 10.1583/07-2287.1.
Durkin MT, Turton EP, Scott DJ, Berridge DC. A prospective randomised trial of PIN versus conventional stripping in varicose vein surgery. Ann R Coll Surg Engl. 1999;81(3):171-174.
Van Rij AM, Jiang P, Solomon C, Christie RA, Hill GB. Recurrence after varicose vein surgery: a prospective long-term clinical study with duplex ultrasound scanning and air plethysmography. J Vasc Surg. 2003;38(5):935-943. doi: 10.1016/s0741-5214(03)00601-3.
Proebstle TM, Gul D, Kargl A, Knop J. Endovenous laser treatment of the lesser saphenous vein with a 940-nm diode laser: early results. Dermatol Surg 2003; 29(4):357–361
Min RJ, Zimmet SE, Isaacs MN, Forrestal MD. Endovenous laser treatment of the incompetent greater saphenous vein. J Vasc Interv Radiol. 2001;12(10):1167-1171. doi: 10.1016/s1051-0443(07)61674-1.
Proebstle TM, Moehler T, Gul D, Herdemann S. Endovenous treatment of the great saphenous vein using a 1,320 nm Nd:YAG laser causes fewer side effects than using a 940 nm diode laser. Dermatol Surg. 2005;31(12):1678-1684. doi: 10.2310/6350.2005.31308.
Corcos L, Dini S, De Anna D, Marangoni O, Ferlaino E, Procacci T, et al. The immediate effects of endovenous diode 808-nm laser in the greater saphenous vein: morphologic study and clinical implications. J Vasc Surg. 2005;41(6):1018-1025. doi: 10.1016/j.jvs.2005.03.002.
Rasmussen LH, Bjoern L, Lawaetz M, Blemings A, Lawaetz B, Eklof B. Randomized trial comparing endovenous laser ablation of the great saphenous vein with high ligation and stripping in patients with varicose veins: short-term results. J Vasc Surg. 2007;46(2):308-315. doi: 10.1016/j.jvs.2007.03.053.
Almeida JI , Kaufman J, Göckeritz O, Chopra P, Evans MT, Hoheim DF, et al. Radiofrequency endovenous ClosureFAST versus laser ablation for the treatment of great saphenous reflux: a multicenter, single-blinded, randomized study (RECOVERY study). J Vasc Interv Radiol. 2009;20(6):752-9. doi: 10.1016/j.jvir.2009.03.008.
Rutherford RB, Padberg FT Jr, Comerota AJ, Kistner RL, Meissner MH, Moneta GL. Venous severity scoring: an adjunct to venous outcome assessment. J Vasc Surg. 2000;31(6):1307-1312. doi: 10.1067/mva.2000.107094.
Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, et al. Prospective randomised study of endovenous radiofrequency obliteration (closure) versus ligation and vein stripping (EVOLVeS): two-year follow-up. Eur J Vasc Endovasc Surg. 2005;29(1):67-73. doi: 10.1016/j.ejvs.2004.09.019.
Mozafar M, Atqiaee K, Haghighatkhah H, Sanei Taheri M, Tabatabaey A, Lotfollahzadeh S. Endovenous laser ablation of the great saphenous vein versus high ligation: long-term results. Lasers Med Sci. 2014;29(2):765-71. doi: 10.1007/s10103-013-1389-z.
Tofigh A M, Karvandi M, Coscas R. Current incidence of peripheral arterial embolism and role of echocardiography. Asian Cardiovasc Thorac Ann. 2008;16(6):439-443. doi: 10.1177/021849230801600602.
Bozoglan O, Mese B, Eroglu E, Ekerbiçer HC, Yasim A. Comparison of endovenous laser and radiofrequency ablation in treating varices in the same patient. J Lasers Med Sci. 2017;8(1):13-16. doi: 10.15171/jlms.2017.03.
He G, Zheng C, Yu MA, Zhang H. Comparison of ultrasound-guided endovenous laser ablation and radiofrequency for the varicose veins treatment: An updated meta-analysis. Int J Surg. 2017;39:267-275. doi: 10.1016/j.ijsu.2017.01.080.
- Abstract Viewed: 511 times
- PDF Downloaded: 280 times