RFA is a minimally invasive procedure in which a catheter is inserted into a target vein lumen. Intense, local heat- based energy through the catheter then obliterates the vein lumen and destroys the wall. EVLA uses laser energy that is absorbed by the target tissue and converted to heat. Both treatments use tumescent anesthesia, a method by which diluted local anesthetic with or without epinephrine and/or sodium bicarbonate are injected around the target vessel. This adjuvant protects the surrounding tissue and collapses the vein wall extrinsically to further ensure the target tissue is ablated in its entirety [7]. By 3 months post-treatment, endothelium is absent and organized thrombus is formed. Occlusion rates for these types of endovenous ablation vary from 91% to 100% within 1-year post- treatment [7,22]. Multiple recent meta-analyses confirm that EVLA and RFA are at least as efficacious, if not slightly more so, than surgery [12,24-26]. When compared to surgery, EVLA had fewer rates of bleeding, hematoma, and wound infection [24]. EVLA and RFA were also noted to have reduced rates of paresthesia compared to surgery [27]. A meta- analysis pooling 52 studies of both RFA and EVLA demonstrated postprocedural thrombotic events infrequently; DVT occurred in 0.3% of cases, and pulmonary embolism occurred in 0.1% of cases [28]. Rates of recurrence between surgery and EVLA had conflicting data, with Paravastu et al [25] noting improved recurrence rates with EVLA at 6 weeks and 1 year and Pan et al [24] noting no significant difference. So far, little difference is seen when comparing the various endovenous treatments in terms of QoL, benefit, and durability [15]. Current data on RFA versus EVLA is rather limited, although there have been some recent Lower Extremity Chronic Venous Disease developments. Gale et al [29] randomized 48 patients into EVLA and 46 patients into RFA, with 11 RFA patients demonstrating recurrence compared with 2 cases of recurrence in the EVLA arm.
Lower Extremity Chronic Venous Disease. RFA is a minimally invasive procedure in which a catheter is inserted into a target vein lumen. Intense, local heat- based energy through the catheter then obliterates the vein lumen and destroys the wall. EVLA uses laser energy that is absorbed by the target tissue and converted to heat. Both treatments use tumescent anesthesia, a method by which diluted local anesthetic with or without epinephrine and/or sodium bicarbonate are injected around the target vessel. This adjuvant protects the surrounding tissue and collapses the vein wall extrinsically to further ensure the target tissue is ablated in its entirety [7]. By 3 months post-treatment, endothelium is absent and organized thrombus is formed. Occlusion rates for these types of endovenous ablation vary from 91% to 100% within 1-year post- treatment [7,22]. Multiple recent meta-analyses confirm that EVLA and RFA are at least as efficacious, if not slightly more so, than surgery [12,24-26]. When compared to surgery, EVLA had fewer rates of bleeding, hematoma, and wound infection [24]. EVLA and RFA were also noted to have reduced rates of paresthesia compared to surgery [27]. A meta- analysis pooling 52 studies of both RFA and EVLA demonstrated postprocedural thrombotic events infrequently; DVT occurred in 0.3% of cases, and pulmonary embolism occurred in 0.1% of cases [28]. Rates of recurrence between surgery and EVLA had conflicting data, with Paravastu et al [25] noting improved recurrence rates with EVLA at 6 weeks and 1 year and Pan et al [24] noting no significant difference. So far, little difference is seen when comparing the various endovenous treatments in terms of QoL, benefit, and durability [15]. Current data on RFA versus EVLA is rather limited, although there have been some recent Lower Extremity Chronic Venous Disease developments. Gale et al [29] randomized 48 patients into EVLA and 46 patients into RFA, with 11 RFA patients demonstrating recurrence compared with 2 cases of recurrence in the EVLA arm.