Laser Ablation vs Radio Frequency Ablation

I am often asked which of the two ablation procedures are better: radiofrequency ablation (RFA) or endovenous laser therapy (EVLT)? It’s actually a very good question. Both of these techniques are "minimally invasive" means of treating venous insufficiency of the large superficial veins (the greater and lesser saphenous veins, specifically), which are the usual cause of varicose veins. Unlike older techniques, both laser and radiofrequency ablation involve no incision, and minimal recovery time. Usually, they are relatively painless to administer.

Often, they are procedures which are performed in the office, rather than in the operating room. Both of these procedures use thermal energy, in the form of laser or radiofrequency energy, to close the blood vessel from the inside, so that the refluxing vein is no longer functional. This improves patient symptoms, by decreasing venous pressure in the leg.

So how are the techniques different and which works better? Radiofrequency ablation uses radiofrequency energy in 20 second bursts. This energy targets the collagen in the vein wall. Targeting the vein wall causes the vein to shrink around the catheter as the vein is being treated. The vein, therefore, actually closes as the treatment is administered. After radiofrequency ablation, the vein is smaller, and thicker, and does not carry blood through it. With time, the vein actually gets absorbed by the tissues in the body, and disappears.

The laser filament, on the other hand, uses a heating element which is quite variable. Laser devices have frequencies which range from 810 to 1470 nanometers (nm). All are designed to target the vein wall. However, this strong energy can cause a lot of collateral damage and can occasionally puncture the vein wall, causing leakage of blood out of the blood vessel, and extensive bruising. When laser does work, it does not cause shrinkage of the blood vessel, but rather causes clot formation in the blood vessel, which then causes the vessel to occlude (it blocks the flow of blood). The problem with this method, is that it is often associated with a lot more lingering pain than radiofrequency ablation.

Both methods have a very high rate of success (closure of the vein). Both are superior to the traditional methods of vein stripping from before. Really, the main difference is that laser ablation is generally associated with more bruising, pain, and discomfort compared to radiofrequency. It is for that reason that radiofrequency ablation is used exclusively at the Spectrum Vein Center.

Here is a video which illustrates the differences between these two techniques.

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