Comparison of Clinical Outcomes of Endovenous Laser Ablation and Radiofrequency Ablation in the Treatment of Primary Varicose Veins: A Single-Center Retrospective Study
Abstract
Objectives: Primary saphenous vein insufficiency, a common cause of chronic venous disease, negatively affects quality of life. Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) have replaced open surgery as minimally invasive treatments because of their high success rates and low complication risks. However, it remains unclear how much concomitant miniphlebectomy and additional truncal vein ablation contribute to the outcomes of these two techniques. This study compared early- and mid-term outcomes of EVLA and RFA, and evaluated the effects of miniphlebectomy, truncal vein ablation, and comorbidities on treatment success.
Materials and Methods: This retrospective single-center study included 498 lower extremities treated with endovenous thermal ablation between January 2021 and February 2026. Patients underwent EVLA (n=400) or RFA (n=98). All procedures were performed by the same surgeon, and concomitant ambulatory miniphlebectomy was performed in all patients. Clinical and duplex ultrasonographic findings obtained at the six-month follow-up were analyzed to assess treatment success, recurrence, and deep vein thrombosis (DVT).
Results: The overall anatomical success rate was 98.19% (97.75% for EVLA, 100% for RFA; p=0.216). Overall DVT and recurrence rates were 0.40% and 1.41%, respectively. Treatment success did not differ between isolated and multitruncal vein ablation (p>0.05) or by comorbidity status (p=1.000). A great saphenous vein diameter of ≥8 mm showed a trend toward higher recurrence, though not statistically significant (p=0.086).
Conclusion: EVLA and RFA demonstrated comparable efficacy and safety in the treatment of primary saphenous vein insufficiency. Concomitant miniphlebectomy and additional truncal vein ablation, when indicated, did not adversely affect treatment success.
Keywords
Venous insufficiency, Endovenous laser ablation, Radiofrequency ablation, Varicose veins, Miniphlebectomy
References
- Bozkurt AK, editor. Periferik arter ve ven hastalıkları: Ulusal tedavi kılavuzu. Istanbul: Türk Kalp ve Damar Cerrahisi Derneği & Ulusal Vasküler ve Endovasküler Cerrahi Derneği; 2021.
- De Maeseneer MG, Kakkos SK, Aherne T, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg. 2022;63:184-267.
- Khan A, Sorour AA, E Anton G, et al. Venous Insufficiency: Endovascular and Surgical Treatment. Curr Cardiol Rep. 2025;27:67.
- Nelzén O. Lower Limb Venous Incompetence and the Effect of Radio Frequency Ablation Versus Open Surgery: Focus on Haemodynamics, Quality of Life and Health Economic Aspects. Linköping; 2023.
- Nicolaides AN. The Most Severe Stage of Chronic Venous Disease: An Update on the Management of Patients with Venous Leg Ulcers. Adv Ther. 2020;37:19-24.
- Proebstle T, van den Bos R. Endovenous ablation of refluxing saphenous and perforating veins. Vasa. 2017;46:159-166.
- Chervonski E, Muqri F, Jacobowitz GR, et al. Safety and efficacy of endovenous ablation in patients with a history of deep vein thrombosis. J Vasc Surg Venous Lymphat Disord. 2024;12:101898.
- Mendez GM, Trevino AIV, Juarez MAS, et al. Retrospective review of endovenous thermic ablation alone versus combined with phlebectomy in the management of varicose veins. Int Surg J. 2024;11:1783-1788.
- Samuel N, Carradice D, Wallace T, et al. Randomized clinical trial of endovenous laser ablation versus conventional surgery for small saphenous varicose veins. Ann Surg. 2013;257:419-426.
- Proebstle TM, Alm BJ, Göckeritz O, et al. Five-year results from the prospective European multicentre cohort study on radiofrequency segmental thermal ablation for incompetent great saphenous veins. Br J Surg. 2015;102:212-218.