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Laser vs. Radiofrequency Ablation: Is one Better than the Other?
The latest advancement in varicose vein treatment is the Endoluminal Ablation technique. This entails advancing a catheter through a very small incision up along the greater or lesser saphenous vein. Heat is then generated at the tip of the catheter and the device is slowly withdrawn. This results in destruction of the vein and ultimately its elimination.
There are two different techniques for this procedure, laser and radiofrequency. The procedure steps are essentially the same requiring a small incision and passage of a catheter. The main difference is the type of energy used to generate the heat. With laser the source is obviously laser light. It is delivered through a transparent filament (shown in figure A). With the radiofrequency, radio-waves are used to generate the heat. Additionally, a pronged tip is used to deliver the energy.
The techniques have both been in use now for some time and good data is starting to come out of studies. The success rate of the two procedures is fairly similar. Laser ablation is 94% and Radiofrequency is about 90% reliable in closing the treated vein. The main differences are in the post-procedure pain and bruising. The radiofrequency technique is performed under direct visualization with ultrasound guidance. Additionally, the radiofrequency catheter has prongs that deliver the heat directly to the vein wall (see Figure B). This allows for good control over the delivery of the heat to the vein. The laser is not directly visualized and the energy is released into the center of the vein. This sometimes results in the laser burning through the vein wall and blood escapes causing the bruising. This can also cause burning of tissue outside of the vein including the skin which results in elevated levels post-operative pain. That said the discomfort is usually well controlled with just over-the-counter anti-inflammatories such as Motrin.p>
Radiofrequency is slightly older than the laser technique but is only manufactured by one company. Laser generators on the other hand are manufactured by numerous companies. If laser is the only technique available in your state don't be surprised. Both techniques are incredible improvements over traditional vein stripping.
By: Eric Davis; PA-C, MPAS