Clinical ResearchA Comparison of 1,470-nm Endovenous Laser Ablation and Radiofrequency Ablation in the Treatment of Great Saphenous Veins 10 mm or More in Size
Introduction
Lower extremity superficial venous insufficiency is a common disease that can progress to venous ulcers unless the clinical symptoms are treated.1 Primary treatment of varicose veins was surgery for many years, although thermal ablation techniques have become increasingly popular in recent years. Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) are safe and minimally invasive techniques used in the treatment of saphenous vein insufficiency. Thermal endovenous ablation using an 810-nm diode laser was the first reported in 2001, by Navarro et al.2 Weiss et al.3 reported cases in which they performed thermal ablation using radiofrequency energy. EVLA and RFA produce similar histopathologic changes in the varicose saphenous vein.4 Damage in the venous wall associated with the heat energy emitted by the tip of the catheter occurs in both techniques, and venous structures are broken down. The vein thus assumes a fibrotic structure. However, although the results are similar, the mechanisms involved in the 2 techniques are different. When laser light is used, heat develops in the optic penetration zone with direct absorption of laser energy (radiation). This intraluminally emitted light energy is absorbed by various substances known as chromophores. These cause tissue damage through photochemical and photothermolytic mechanisms by reflecting this energy back to the tissues. In the radiofrequency technique, on the other hand, when the radiofrequency waves make contact with tissue by producing electromagnetic energy, this causes the collagen in connective tissue to break down by setting up vibration and abrasion. The most characteristic property of RFA is that it exhibits this effect at much lower temperatures (90–120°C) compared with other sources of energy. The radiofrequency catheter therefore has to be in direct contact with the tissue to produce effective thermal destruction. Because laser catheters are capable of reaching temperatures up to 700°C, they can cause perforation when they come into direct contact with tissue. There is therefore a prevailing opinion that because the radiofrequency catheter will not be able to make direct contact with the vein wall when the diameter of the saphenous vein exceeds 10 mm, its effectiveness may be quite low. The purpose of this study was to test that hypothesis by comparing 1470-nm EVLA and RFA in the treatment of superficial venous insufficiency in patients with a saphenous diameter of 10 mm or more in the saphenofemoral region.
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Materials and Methods
One hundred twenty patients presenting to the cardiovascular surgery department between January and December 2013, and with a saphenous vein diameter of 10 mm or more at the level of the saphenofemoral joint (SFJ) were enrolled. Patients were randomly assigned into 1 of 2 groups after local ethical committee approval. Patients in group 1 received laser ablation and those in group 2 received RFA. Patients with a saphenous vein diameter less than 10 mm at the SFJ were excluded. Before the
Results
All patients had primary etiology, and pathophysiology in the entire extremity was associated with reflux. There was no statistical difference between extremities on the basis of CEAP and VCSS classifications at preoperative assessments. Mean duration of reflux in the SFJ was 3.7 sec in the EVLA group and 4.1 sec in the RFA group. EVLA and RFA procedures were performed on a total of 60 saphenous veins each. The mean diameter of the saphenous vein at the level of the SFJ was 11.3 mm and the mean
Discussion
The 2 most commonly used alternatives to surgery in the treatment of varicose veins in recent years are EVLA and endovenous RFA. Both methods involve similar mechanisms, are safe, effective, minimally invasive, and easy to perform with high occlusion rates in saphenous vein insufficiency. The absence of any requirement for general anesthesia or hospitalization, early mobilization, low complication and recurrence rates, and high patient satisfaction compared with surgery mean that EVLA and RFA
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Conflict of Interest: The authors declare that there is no conflict of interest.