Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 7  |  Issue : 3  |  Page : 227-230

Comparative analysis of early outcomes of radiofrequency ablation and 1470-nm endovenous laser ablation in the treatment of great saphenous vein insufficiency


Department of Vascular and Endovascular Surgery, Yashoda Hospital, Hyderabad, Telangana, India

Date of Submission05-Oct-2019
Date of Decision05-Jan-2020
Date of Acceptance05-Feb-2020
Date of Web Publication12-Sep-2020

Correspondence Address:
Saleem Jahangir
Department of Vascular and Endovascular Surgery, Yashoda Hospital, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_82_19

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  Abstract 


Background: Minimally invasive Endovenous Thermal Ablation Therapy has revolutionized the treatment of varicose veins. Comparison of radiofrequency ablation (RFA) and Endovenous Laser Ablation (EVLA) needs to be more elaborated in the context of better management of patients. The objective of this study is to compare 1470-nm endovenous laser Ablation (EVLA) and radiofrequency ablation (RFA) in the treatment of patients with great saphenous vein Insufficiency. Methods: There were 100 consecutive patients presenting to our department with a great saphenous vein insufficiency treated between June 2018 and June 2019 who were included in the study. The first randomly selected 50 patients (group 1) received 1470-nm EVLA and the other 50 patients (group 2) received RFA. Patients were assessed on the second day, the first week, and the first month in terms of post-operative complications, return to routine activity and work, and postoperative pain. Results: 50 patients were allocated to each group. There was no statistically significant difference between two groups in terms of postoperative pain. Time to return to daily activity was 5.1 ± 1.12 hours in the EVLA group and 6.9 ± 0.93 hours in the RFA group (P = 0.001), whereas time to return to work was 6.7 ± 1.03 days in the EVLA group and 7.4 ± 1.07 days in the RFA group (P = 0.003). Minor complications in EVLA and RFA group were ecchymosis 26% and 32% (P = 0.509) edema 24% and 34% (P = 0.271), and induration 14% and 22% (P = 0.298), respectively. No major complication were observed in any group. Conclusion: EVLA using a 1470-nm radial fiber is an acceptable and efficacious treatment option over RFA in management of symptomatic varicose veins patients in terms of early outcome. However, long term follow up and more studies on larger populations are required to establish the superiority of either method.

Keywords: Endovenous laser ablation, radiofrequency ablation, varicose veins


How to cite this article:
Prabakar D, Jahangir S. Comparative analysis of early outcomes of radiofrequency ablation and 1470-nm endovenous laser ablation in the treatment of great saphenous vein insufficiency. Indian J Vasc Endovasc Surg 2020;7:227-30

How to cite this URL:
Prabakar D, Jahangir S. Comparative analysis of early outcomes of radiofrequency ablation and 1470-nm endovenous laser ablation in the treatment of great saphenous vein insufficiency. Indian J Vasc Endovasc Surg [serial online] 2020 [cited 2020 Dec 5];7:227-30. Available from: https://www.indjvascsurg.org/text.asp?2020/7/3/227/294916




  Introduction Top


Varicose vein existence has been documented as old as Hippocrates.[1] For many years, the most frequently employed therapeutic option in the treatment of great saphenous vein (GSV) insufficiency was ligation and stripping. There has been continual research into treating the disease with thermal ablation techniques. Over the few decades, thermal ablation techniques have become popular. Venous wall sclerosing using thermal methods has recorded considerable satisfaction among patients and physicians. Application of thermal endovenous ablation using an 810-nm diode laser was first published in 2001.[2] Since then, numerous studies have been performed using different wavelengths and types of laser.[3],[4],[5],[6],[7] Different laser wavelengths have been used to generate endothelial destruction of varicose veins, including lengths of 810, 940, 980, 1064, 1319, 1320, and 1470 nm. In 1999, the Food and Drug Administration granted permission for the use of radiofrequency energy in endovenous ablation. Patients receiving thermal ablation using radiofrequency energy were first reported in 2002.[8] Studies using radiofrequency ablation (RFA) were subsequently published.[9],[10] Comparative studies of endovenous laser ablation (EVLA) and RFA then started being published. Equal success between EVLA and RFA was reported, with fewer side effects and greater patient satisfaction with RFA.[11],[12] However, all these studies compared laser energy at low wavelengths (810, 940, and 980 nm) with radiofrequency. Compared to low-wavelength laser energy and bare fiber, high-wavelength laser energy and radial fiber have been shown to produce better patient satisfaction and fewer side effects.[13] In the literature, studies comparing laser energy at a wavelength of 1470 nm with RFA are not much. The objective of this study was to compare patients receiving EVLA with radial fiber of 1470 nm wavelength and patients receiving RFA in terms of early outcome.


  Methods Top


In this prospective analysis, 100 consecutive patients between June 2018 and June 2019 who underwent endovenous GSV ablation were reviewed. All patients with documented GSV incompetence and symptomatic varicose veins were classified according to the clinical severity, etiology, anatomy, and pathophysiology (CEAP) classification. Clinical data, operative details, and postoperative course were analyzed. Laser source (Lasotronix, diode laser) with a radial fiber of wavelength of 1470 nm was used for EVLA, and an endovenous radiofrequency device (Covidien ClosureFAST) and a catheter were used for RFA.

Description of techniques

Before surgery, lower extremity varicosities were marked in the standing position in preparation for stab avulsions. These outpatient procedures were performed in the operating room under sedation and tumescent anesthesia. The GSV was punctured with an 18-gauge needle under duplex ultrasound guidance. 7 Fr and 5 Fr sheaths were placed in GSV in RFA and EVLA patients, respectively. Laser or radiofrequency catheter was advanced into GSV and its position confirmed 2 cm distal to SFJ. Tumescent anesthesia infiltrated under duplex ultrasound guidance from knee to groin around the GSV. The GSV was treated with either RFA or EVLA. Successful obliteration was confirmed by intraoperative duplex ultrasound scans. Microphlebectomies and other concomitant procedures such as foam sclerotherapy were performed when indicated. At the completion of the operation, a two-layer compressive dressing was applied from the foot to the groin. Early ambulation was done. Patients were discharged the next day because most of them had health insurance coverage and some procedures were done late in the day. Pain after the procedure was reviewed using a visual analog scale. An elastic bandage was applied for compression and stockings were suggested for 3 months to improve the efficacy of treatment by reducing the diameter of treated veins and by lessening reflux during walking. Time to return to routine activities and return to work were recorded.

Patients were reviewed clinically on day 1 of surgery and followed up after 1 week and 1 month. Major and minor complications were noted.

Statistical analysis

All statistical calculations were performed using the SPSS version 24.0 software (SPSS Inc., Chicago, IL, USA). Demographic and postoperative data were compared using Student's t-test, and preoperative CEAP and postoperative complication data were assessed using Chi- square test. All reported P values were based on two-sided tests, and P < 0.05 was considered statistically significant.


  Results Top


Pathophysiology in all patients was associated with reflux and all patients had primary etiology. There was no significant difference between age, venous clinical severity score (VCSS), and CEAP of both Group I (ELVA) and Group II (RFA) [Table 1]. [Figure 1] and [Figure 2] represent the patient distribution in each group. Postoperative pain score was 1.1 in the EVLA group and 1.3 in the RFA group [Table 2]. The difference was statistically significant (P = 0.012). Time to return to daily activity was 5.1 ± 1.12 h in the EVLA group and 6.9 ± 0.93 h in the RFA group, and the difference was statistically significant (P = 0.001). Time to return to work was 6.7 ± 1.03 days in the EVLA group and 7.4 ± 1.07 days in the RFA group, and the difference was statistically significant (P = 0.003) [Figure 3] and [Figure 4].
Table 1: Preoperative data

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Figure 1: Age distribution

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Figure 2: Preprocedure data

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Table 2: Postoperative data

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Figure 3: Postoperative pain

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Figure 4: Postoperative return to activity and work

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No major complications such as deep venous thrombosis and pulmonary embolism were observed in any patient. Minor complications which resolved mostly at the end of 1 week were ecchymosis and edema induration. Induration developed in 14% of the patients in the EVLA group and 22% of those in the RFA group. The difference was not statistically significant (P = 0.298). Ecchymosis developed in 26% of the patients in the EVLA group and in 32% of those in the RFA group. The difference was not statistically significant (P = 0.509). Edema developed in 24% of the patients in the EVLA group and 34% of those in the RFA group. The difference was not statistically significant (P = 0.271) [Figure 5]. Induration, ecchymosis, and edema resolved mostly at the end of 1 week [Table 3].
Figure 5: Postoperative complications

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Table 3: Complications after endovenous laser therapy and radiofrequency ablation

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  Discussion Top


Lower extremity varices with chronic venous insufficiency significantly affect the quality of life.[14] There is a significant evolution in the management of varicose veins over the last few decades. Conventional surgery has been replaced with endovenous ablation techniques to a larger extent. RFA and EVLA have become the most commonly used thermal ablation techniques. There is no general consensus on which method is superior. Multiple studies are published comparing these two ablation techniques. Previous studies have concluded that both methods have the same levels of successful ablation, but complications and pain following EVLA are higher compared to RFA.[15],[16],[17],[18] These studies have compared low wavelength laser with RFA. Several recent studies suggest that better results are achieved with higher laser wavelengths. Better patient comfort has been reported with 1470 nm radial laser fiber and bare fiber with a wavelength of 980 nm.[13] Therefore, laser fiber at a wavelength of 1470 nm needs to be compared with RFA for better conclusions. Most previous studies have reported greater patient satisfaction of RFA over EVLA.[11]

In our study, patient satisfaction was higher in the EVLA group. Better results for criteria such as postoperative pain, return to activity, and return to work were obtained in the EVLA group in our study. Postoperative pain, time to return to activity, and time to return to work were statistically significant (P = 0.012, P = 0.001, and P = 0.003, respectively). High-wavelength lasers use water as a chromophore and therefore are able to penetrate the vein wall better. Radial fibers disseminate homogeneous pattern of rays and subsequently there is an equal contact with the vein wall which reduces the incidence of perforation. In this study, no major complications developed. Minor complication levels were lower in the EVLA group as compared to RF though it was not clinically significant.


  Conclusion Top


The present study findings showed that there was lesser postoperative complications and better patients satisfaction in the EVLA group compared to the RFA group. Therefore, EVLA at a wavelength of 1470 nm and using radial fiber is superior to RFA technique in terms of early outcome. However, long-term follow-up and more studies on larger populations are required to establish the supremacy of either method.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
van den Bremer J, Moll FL. Historical overview of varicose vein surgery. Ann Vasc Surg 2010;24:426-32.  Back to cited text no. 1
    
2.
Navarro L, Min RJ, Boné C. Endovenous laser: A new minimally invasive method of treatment for varicose veins – Preliminary observations using an 810 nm diode laser. Dermatol Surg 2001;27:117-22.  Back to cited text no. 2
    
3.
Proebstle TM, Lehr HA, Kargl A, Espinola-Klein C, Rother W, Bethge S, et al. Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: Thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles. J Vasc Surg 2002;35:729-36.  Back to cited text no. 3
    
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Yu DY, Chen HC, Chang SY, Hsiao YC, Chang CJ. Comparing the effectiveness of 1064 vs. 810 nm wavelength endovascular laser for chronic venous insufficiency (Varicose Veins). Laser Ther 2013;22:247-53.  Back to cited text no. 4
    
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Goldman MP, Mauricio M, Rao J. Intravascular 1320-nm laser closure of the great saphenous vein: A 6- to 12-month follow-up study. Dermatol Surg 2004;30:1380-5.  Back to cited text no. 5
    
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Vuylsteke ME, Vandekerckhove PJ, De Bo T, Moons P, Mordon S. Use of a new endovenous laser device: Results of the 1,500 nm laser. Ann Vasc Surg 2010;24:205-11.  Back to cited text no. 7
    
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Weiss RA, Weiss MA. Controlled radiofrequency endovenous occlusion using a unique radiofrequency catheter under duplex guidance to eliminate saphenous varicose vein reflux: A 2-year follow-up. Dermatol Surg 2002;28:38-42.  Back to cited text no. 8
    
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Park JY, Galimzahn A, Park HS, Yoo YS, Lee T. Midterm results of radiofrequency ablation for incompetent small saphenous vein in terms of recanalization and sural neuritis. Dermatol Surg 2014;40:383-9.  Back to cited text no. 9
    
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Badham GE, Strong SM, Whiteley MS. Anin vitro study to optimise treatment of varicose veins with radiofrequency-induced thermo therapy. Phlebology 2015;30:17-23.  Back to cited text no. 10
    
11.
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;20:752-9.  Back to cited text no. 11
    
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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;98:1079-87.  Back to cited text no. 12
    
13.
Doganci S, Demirkilic U. Comparison of 980 nm laser and bare-tip fibre with 1470 nm laser and radial fibre in the treatment of great saphenous vein varicosities: A prospective randomised clinical trial. Eur J Vasc Endovasc Surg 2010;40:254-9.  Back to cited text no. 13
    
14.
Evans CJ, Fowkes FG, Ruckley CV, Lee AJ. Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh Vein Study. J Epidemiol Community Health 1999;53:149-53.  Back to cited text no. 14
    
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Puggioni A, Kalra M, Carmo M, Mozes G, Gloviczki P. Endovenous laser therapy and radiofrequency ablation of the great saphenous vein: Analysis of early efficacy and complications. J Vasc Surg 2005;42:488-93.  Back to cited text no. 15
    
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Gale SS, Lee JN, Walsh ME, Wojnarowski DL, Comerota AJ. A randomized, controlled trial of endovenous thermal ablation using the 810-nm wavelength laser and the ClosurePLUS radiofrequency ablation methods for superficial venous insufficiency of the great saphenous vein. J Vasc Surg 2010;52:645-50.  Back to cited text no. 16
    
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Shepherd AC, Gohel MS, Brown LC, Metcalfe MJ, Hamish M, Davies AH. Randomized clinical trial of VNUS ClosureFAST radiofrequency ablation versus laser for varicose veins. Br J Surg 2010;97:810-8.  Back to cited text no. 17
    
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Shepherd AC, Gohel MS, Lim CS, Hamish M, Davies AH. Pain following 980-nm endovenous laser ablation and segmental radiofrequency ablation for varicose veins: A prospective observational study. Vasc Endovascular Surg 2010;44:212-6.  Back to cited text no. 18
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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