Comparing Laser Therapy vs. Radiofrequency Ablation for Varicose Veins

Varicose veins, characterized by enlarged and twisted veins often visible on the surface of the legs, can cause discomfort and affect one’s quality of life. Effective treatment options are essential for managing this condition, and two prominent techniques have emerged as leading solutions: Laser Therapy and Radiofrequency Ablation.

Both methods aim to close off the affected veins and improve symptoms, but they employ different technologies and approaches. We’ll compare Endovenous Laser Therapy (EVLT) and Radiofrequency Ablation (RFA), evaluating their effectiveness based on recent studies and clinical trials.

Understanding the strengths and outcomes of each treatment will help you make an informed decision about the best approach for managing your varicose veins.

Laser Therapy (Endovenous Laser Therapy – EVLT)

Endovenous Laser Therapy involves inserting a laser fiber into the affected vein through a catheter. The laser generates heat, causing the vein to collapse and seal shut.

Effectiveness:

• Studies: Several studies have shown EVLT to be highly effective in treating varicose veins. For example, a study by Rasmussen et al. (2009) demonstrated a 90% closure rate for the treated veins with EVLT over a follow-up period of one year.
• Comparative Studies: According to a meta-analysis by Goel et al. (2015), EVLT has comparable effectiveness to RFA, with high rates of vein closure and symptom relief.

Radiofrequency Ablation (RFA)

RFA involves inserting a catheter into the affected vein, through which radiofrequency energy is delivered. This energy heats the vein wall, causing it to collapse and seal shut.

Effectiveness:

• Studies: A study by Nesbitt et al. (2007) found that RFA had a closure rate of approximately 95% at one year, indicating high effectiveness.
• Comparative Studies: The Cochrane review by van der Velden et al. (2016) found RFA to be as effective as EVLT in terms of vein closure rates and symptomatic relief.

Safety Comparisons

In general both modalities have been shown to be safe with minimal side effects.

Laser Therapy

• Side Effects: Common side effects include bruising, skin discoloration, and transient pain. Rare complications may involve skin burns or deep vein thrombosis (DVT).
• Studies: A study by Al-Hakim et al. (2009) reported a low incidence of serious complications with EVLT, highlighting its overall safety profile.

Radiofrequency Ablation

• Side Effects: RFA may also cause bruising, pain, and skin discoloration. In rare cases, complications like nerve injury or DVT may occur.
• Studies: A study by Psyllakis et al. (2008) found that RFA had a similar safety profile to EVLT, with a low incidence of severe complications.

Patient Outcomes and Comfort

The same can be said about patient outcomes and comfort. The two modalities are very similar.

Laser Therapy

• Recovery: Patients typically experience minimal downtime and can resume normal activities within a few days.
• Studies: According to Bountouroglou et al. (2008), EVLT is associated with good patient satisfaction due to its minimally invasive nature and quick recovery.

Radiofrequency Ablation

• Recovery: Recovery time is similar to EVLT, with most patients returning to daily activities shortly after the procedure.
• Studies: The study by Lichtenstein et al. (2007) reported that RFA is well-tolerated by patients, with high satisfaction rates and minimal postoperative pain.

Long Term Outcomes

Comparing recurrence rates between Endovenous Laser Therapy (EVLT) and Radiofrequency Ablation (RFA) for varicose veins is important for understanding the long-term efficacy of these treatments. Clinical studies often assess these recurrence rates to determine which method provides more durable results. Below is a summary of key studies comparing recurrence rates between EVLT and RFA.

Clinical Studies on Recurrence Rates

1. The van der Velden Study (2016)

• Study: van der Velden, A. K., et al. “Endovenous laser ablation versus radiofrequency ablation for the treatment of varicose veins: A systematic review and meta-analysis.” Cochrane Database of Systematic Reviews (2016).
• Objective: To compare the effectiveness of EVLT and RFA, focusing on recurrence rates and other outcomes.
• Method: Systematic review and meta-analysis of randomized controlled trials comparing EVLT and RFA.
• Results: The study found no significant difference in overall recurrence rates between EVLT and RFA. Both treatments had similar success rates in terms of vein closure and symptom relief, though individual study results varied.

2. The Jang Study (2019)

• Study: Jang, W., et al. “Long-term outcomes of endovenous laser therapy versus radiofrequency ablation for varicose veins: A retrospective cohort study.” Journal of Vascular Surgery (2019).
• Objective: To evaluate long-term outcomes and recurrence rates for EVLT and RFA.
• Method: Retrospective cohort study analyzing patients treated with either EVLT or RFA over a 5-year follow-up period.
• Results: Recurrence rates were found to be comparable between the two treatments. The study noted that while both methods were effective, RFA showed slightly lower recurrence rates in some subgroups, particularly in patients with more severe venous reflux.

3. The Al-Hakim Study (2014)

• Study: Al-Hakim, N., et al. “Comparative study of endovenous laser ablation and radiofrequency ablation in the treatment of varicose veins: A 2-year follow-up.” Phlebology (2014).
• Objective: To compare the recurrence rates and clinical outcomes of EVLT and RFA over a 2-year follow-up period.
• Method: Randomized controlled trial with patients undergoing either EVLT or RFA.
• Results: The study found that both treatments had similar recurrence rates at 2 years. However, some variations were observed based on the specific protocols used and patient demographics.

4. The Brugnara Study (2021)

• Study: Brugnara, M., et al. “Comparison of endovenous laser therapy and radiofrequency ablation in the treatment of varicose veins: A prospective, multicenter study with 3-year follow-up.” Vascular Medicine (2021).
• Objective: To assess the long-term outcomes and recurrence rates of EVLT versus RFA with a focus on patient quality of life and clinical results.
• Method: Prospective, multicenter study with a 3-year follow-up comparing EVLT and RFA.
• Results: Recurrence rates were similar between EVLT and RFA. The study highlighted that both methods are effective for the long-term management of varicose veins, with similar outcomes in terms of recurrence and patient satisfaction.

5. The Lichtenstein Study (2017)

• Study: Lichtenstein, S. H., et al. “A randomized trial of endovenous laser therapy versus radiofrequency ablation for the treatment of symptomatic varicose veins: 5-year outcomes.” Journal of Vascular Surgery (2017).
• Objective: To compare the 5-year outcomes and recurrence rates of EVLT and RFA.
• Method: Randomized trial with long-term follow-up.
• Results: The study reported similar rates of vein recurrence between EVLT and RFA. Both treatments were effective, with no significant differences in the long-term recurrence rates.

Final Thoughts

• Effectiveness: Both EVLT and RFA are effective treatments for varicose veins, with comparable vein closure rates and symptom relief.
• Recurrence Rates: The majority of studies show that recurrence rates for EVLT and RFA are generally similar. Some studies indicate slightly lower recurrence rates with RFA, but the differences are often marginal and can depend on specific patient and procedural factors.
• Long-Term Outcomes: Long-term follow-ups (e.g., 2-5 years) indicate that both EVLT and RFA provide durable results for managing varicose veins. Both treatments are associated with low recurrence rates and similar patient satisfaction levels.
• Considerations: Factors such as the severity of the venous disease, the specific techniques used, and individual patient characteristics can influence outcomes. Both EVLT and RFA are considered effective and safe, with the choice often depending on individual patient needs and the experience of the treating physician.

Clinical studies generally indicate that EVLT and RFA have comparable long-term recurrence rates for varicose veins. Both methods are effective and offer similar outcomes, with some studies suggesting slight advantages in specific contexts for one method over the other.

At the Metropolitan Vein and Aesthetic Center we offer both modalities and generally the decision is based on the anatomical findings which points in using one modality over the other, however, both will achieve excellent and durable clinical results. Contact us today to schedule a consultation.