Endoluminal treatment of lower limb varicose veins by endovenous laser and radiofrequency techniques

Objective: New endovenous treatment techniques for varicose veins – endovenous laser (EVLT) and radiofrequency (RF) – have been the subject of numerous publications during recent years. The aim of this study was to analyse the articles published in English and French and to compare the two procedures with classical surgery. Methods: While RF uses only one type of device, manufactured and distributed by a sole company, EVLT uses different types of lasers, manufactured and marketed by several companies. Therefore, RF benefits from a unique and well-defined protocol of practice, in contrast with EVLT which presents multiple variants. Results: The short-term postoperative clinical status was studied in two controlled randomized trials comparing RF therapy with classical surgery, including one study that used a quality of life questionnaire. The results, including return to normal activity and convalescence duration assessment, were more favourable after RF therapy. In terms of thromboembolic complications investigated by systematic ultrasound duplex examination, the two procedures presented an approximately equal success rate of 0.5%. Other postoperative complications were transient: RF was associated with sensory nerve complications like paresthesia, while pain was more pronounced after EVLT. Results were difficult to analyse in terms of varicose vein treatment. In terms of signs and symptoms, detailed results were available at the three-year follow up for RF therapy. The improvement was very significant compared with the preoperative status and roughly equivalent to that previously reported for classical surgery. Clinical results after EVLT are less documented. Haemodynamic results by duplex ultrasound examination are well documented for RF but less detailed for EVLT. In a single-centre study, vein obliteration after EVLT was 93.4% at the two-year follow up and 88% after RF in a multicentre study at the three-year follow up. Correlation between clinical and haemodynamic results was established for RF at the two-year follow up and showed a strong link between the clinical results and absence of reflux. Finally, cost estimation of the two techniques showed that the EVLT fibre is cheaper than the RF catheter, the situation being inverse for the generators. The global cost of the RF procedure (including convalescence) was compared with classical surgery in a study. The findings favour RF for active patients. Conclusions: In the absence of long-term controlled results comparing classical surgery and sclerotherapy with endoluminal surgery, the latter method was proved to be less aggressive postoperatively and effective at mid-term.