Radiofrequency Ablation

Radiofrequency (Rf)  ablation is a minimally invasive treatment for varicose veins that uses radiofrequency energy (instead of laser energy) to heat up and damage the wall inside a vein.

There are many similarities but a number of differences between the two systems. Both systems do a very good job of ablating saphenous veins and result in far better recovery and longer-term outcomes than surgical vein stripping.

ANAESTHETIC Local tumescent Local tumescent
HEAT 1000 degrees C 120 degrees C
ENTRY HOLE Small (16g IV cannula) Large (7 French introducer)
SPEED Slow (7cm in 70 seconds) Fast (7cm in 20 seconds)
$$$ CAPITAL OUTLAY YES NO (not often)
VEINS TREATED Many (expert user) Few
Saphenous, accessory vein Saphenous veins
Branch veins, perforator veins Perforator (special sytlet)

Some Surgeons claim to have chosen Rf over laser because it is associated with a less painful recovery than following laser. This was certainly true in the past as older generation lower frequency laser equipment using cheaper “bare fibres” was associated with a higher level of postoperative pain.

Patients should be aware that surgeons and Phlebologists using equipment older then 5yrs may be using lower frequency (< 1470 nm) laser associated with a more painful recovery. Older and cheaper “bare “ fibres are also associated with more painful recovery than modern “radial “ fibres.

Most experience phlebolgists with experience of both systems prefer the great flexibility of laser over RF with ability to treat short segments, non saphenous veins and in the case of the expert user perforator veins. The entry hole with laser can be considerably smaller and less prone to bleed.

Whilst there is little published “head to head” evidence comparing the newest laser technology with Rf my own experience and that of one of the worlds largest users of both technologies (Dr James Lawson from the Nederland’s) is that the two have an identical post op recovery and laser has many advantages and greater flexibility

My personal belief is that surgeons often prefer Rf over laser not because of patient care concerns but for the following reasons.

Rf Catheter

1/ Easy to learn - Use of the Rf system requires far less technical skill than laser. The RF catheter is very forgiving and if the tumescent needle hits the catheter it will not damage it. Surgeons generally do not have high levels of experience with ultrasound and ultrasound guided procedure so this technology is generally "safe" in their hands. In contrast Laser fibres may break and serious consequences can occur if inexperienced users attempt to do EVLA.

2/ Speed - The ablation after tumescent anaesthesia with Rf can be more than three times faster than laser i.e. 2 minutes vs 7 minutes. This difference is of little concern for most phlebologists but for some busy Surgeons every seconds counts and this could mean being able to treat one extra patient per day.

3/ Financial – Rf companies often supply Rf generators “free” only charging for consumables. This means the surgeon that “dabbles” in endovenous ablation can avoid the high capital outlay that the dedicated phlebologist has when purchasing a laser.

4/ Room set up – Special laser safety precautions and safety eyewear are not required for Rf meaning it is easier and cheaper to set up a treatment room that uses Rf compared to one that uses laser.

The success rate of  RF treatment is reportedly slightly lower than that of endovenous laser ablation but in experienced hands there really little difference in success between the two systems.

There is a slightly higher reported rate of phlebitis, hyperpigmentation and paraesthesia following Rf compared to laser.

For all of the reasons above The Vein Clinic uses laser as the primary thermal endovenous ablation technique but does have Rf available if patients have a preference for Rf over laser.

  • University of Melbourne