Varicose-vein study shows radio-frequency ablation bests endovenous laser ablation, but only temporarily
London, England--Vascular-surgery experts from the Imperial College compared endovenous laser ablation (EVLA) to radio-frequency ablation (RFA) for treating varicose veins. The result: patients who received RFA reported less post-procedural pain, but after six weeks both groups reported the same clinical and quality of life improvements.1
131 patients were randomized into two groups, with 64 receiving 980 nm EVLA and 67 receiving RFA. The results showed lower pain levels and analgesia use in the RFA group, together with a faster return to normal activities. (RFA is a non-optical procedure in which high-frequency current is used to destroy tissue.)
All the procedures were carried out under general anesthetic between July 2008 and July 2009 by one of three surgeons experienced in both techniques. The 89 female and 42 male patients were then asked to fill in diary cards recording pain levels, based on a visual analogue scale from zero to 100, and note any analgesia use.
The patients were an average 49 years old; there were no statistically significant differences in other factors such as their body mass index and the pattern of the disease between the two surgical groups.
The use of EVLA and RFA has steadily increased in the UK since 2001, when the National Institute for Health and Clinical Excellence--which advises the National Health Service--approved their use, said Alun Davies of Imperial College. He noted that both techniques are minimally invasive, and their development has revolutionized the treatment of varicose veins.
Key findings of the study:
--Average pain scores for the first three days after surgery were 26.4 on the zero to 100 scale for the RFA group and 36.8 for the EVLA group.
--The average scores for the first 10 days after surgery were 22.0 for the RFA group and 34.3 for the EVLA group.
--Patients treated with RFA used an average of 8.8 analgesic tablets during the first three days and 20.4 over the first ten days. This was much lower than the 14.2 and 35.9 used by the EVLA group.
--60% of the RFA group and 50% of the EVLA group returned to normal activities after three days, with 77% and 74% respectively resuming normal activities within seven days. Return to work figures were similar for both groups.
--Only two major complications were observed. A patient in the RFA group suffered a pulmonary embolus two weeks after surgery and a patient in the EVLA group suffered a lymphatic leak.
--The most common minor complications were tingling, pricking, or numbness (10%), vein inflammation (6%) and skin staining (6%).
--There was little difference in clinical and quality of life scores between the two groups six weeks after surgery.
Looking forward to newer laser wavelengths
"Newer radial fibers and longer laser wavelengths have been developed for EVLA and are likely to replace the 980 nm bare-tip laser fiber," said Davies. "We await the results of randomized trials using these with interest."
REFERENCE
1. A. C. Shepherd et al., British Journal of Surgery, Published Online: May 10 2010; DOI: 10.1002/bjs.7091
--posted by John Wallace