{"id":183,"date":"2025-10-03T01:12:26","date_gmt":"2025-10-03T01:12:26","guid":{"rendered":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/?page_id=183"},"modified":"2025-10-16T03:21:57","modified_gmt":"2025-10-16T03:21:57","slug":"radio-frequency-ablation-endovenous-laser-ablation-for-varicose-veins","status":"publish","type":"page","link":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/index.php\/radio-frequency-ablation-endovenous-laser-ablation-for-varicose-veins\/","title":{"rendered":"Radio Frequency Ablation &#038; Endovenous Laser Ablation for Varicose Veins"},"content":{"rendered":"<div class=\"wpb-content-wrapper\">[vc_row full_width=&#8221;stretch_row&#8221; content_placement=&#8221;middle&#8221; equal_height=&#8221;yes&#8221; rtl_reverse=&#8221;yes&#8221; remove_bottom_col_margin=&#8221;true&#8221; columns_right=&#8221;yes&#8221; wpex_bg_color=&#8221;#03a3de&#8221; min_height=&#8221;350px&#8221;][vc_column width=&#8221;1\/2&#8243;]<style>.vcex-image.vcex_69d090b4680cd .vcex-image-img{object-position:right top;}<\/style><figure class=\"vcex-image vcex-module vcex-fill-column vcex_69d090b4680cd\"><div class=\"vcex-image-inner wpex-relative wpex-w-100 vc_custom_1760584915861\"><img width=\"1210\" height=\"657\" src=\"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/wp-content\/uploads\/2025\/10\/Radio-Frequency-Ablation-Endovenous-Laser-Ablation-_for-Varicose-Veins-copy.webp\" class=\"vcex-image-img wpex-align-middle wpex-w-100\" alt=\"\" loading=\"lazy\" decoding=\"async\" srcset=\"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/wp-content\/uploads\/2025\/10\/Radio-Frequency-Ablation-Endovenous-Laser-Ablation-_for-Varicose-Veins-copy.webp 1210w, https:\/\/cmcdeploytwo.co.nz\/vsoanz\/wp-content\/uploads\/2025\/10\/Radio-Frequency-Ablation-Endovenous-Laser-Ablation-_for-Varicose-Veins-copy-300x163.webp 300w, https:\/\/cmcdeploytwo.co.nz\/vsoanz\/wp-content\/uploads\/2025\/10\/Radio-Frequency-Ablation-Endovenous-Laser-Ablation-_for-Varicose-Veins-copy-1024x556.webp 1024w, https:\/\/cmcdeploytwo.co.nz\/vsoanz\/wp-content\/uploads\/2025\/10\/Radio-Frequency-Ablation-Endovenous-Laser-Ablation-_for-Varicose-Veins-copy-768x417.webp 768w\" sizes=\"auto, (max-width: 1210px) 100vw, 1210px\" \/><\/div><\/figure>[\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_column_text css=&#8221;.vc_custom_1759453922316{padding-top: 20px !important;padding-bottom: 20px !important;}&#8221; color=&#8221;#fefefe&#8221;]\n<h1><strong>Radio Frequency Ablation &amp;<\/strong><br \/>\nEndovenous Laser Ablation for Varicose Veins<\/h1>\n[\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1759015527111{margin-top: 60px !important;}&#8221;][vc_column][vc_tta_tour controls_size=&#8221;md&#8221; active_section=&#8221;1&#8243;][vc_tta_section title=&#8221;What is radiofrequency ablation (RFA)?&#8221; tab_id=&#8221;1759012899351-dcaaabe1-cd5ce869-cab5&#8243;][vc_column_text css=&#8221;&#8221;]Endovenous laser ablation (EVLA) and Radiofrequency ablation (RFA) are techniques that have become available over the last 10-15 years for the treatment of varicose veins. As a general rule these techniques will only deal with the underlying cause\/source of their varicose veins. These techniques, for most patients, do not remove or destroy the visible varicose veins.<\/p>\n<h2 class=\"wp-block-heading\">What is radiofrequency ablation (RFA)?<\/h2>\n<p>Radiofrequency ablation is a minimally invasive technique to destroy the greater saphenous vein (GSV) in the thigh and\/or the small saphenous vein (SSV) at the back of the calf. Both of these veins commonly feed into visible varicose vein. RFA may occasionally be used for other veins such as the anterolateral thigh vein and there is a dedicated RFA device available for treating perforating veins.<\/p>\n<p>RFA is essentially bipolar diathermy. Diathermy refers to electrically induced heat and the bipolar indicates that the electrical current does not pass through the body only through the catheter. By passing an electrical current through a bipolar catheter inside the vein heat is generated and temperatures of 120\u00b0C are attained. The heat produced destroys the vein but the procedure relies on direct contact between the catheter and the vein wall. To facilitate the process the vein needs to be as tightly wrapped around the catheter as possible so compression is applied to the vein using tumescent anaesthesia and external compression and the leg is elevated to collapse the vein. There is an electrical feedback mechanism integrated into the fibre which can alter the energy delivery to maintain a constant temperature.<\/p>\n<p>There is one dominant RFA\u00a0device, the VNUS ClosureFast\u2122 (Covidien). There is another device \u2013 the Olympus Celon RFITT\u2122 which uses a continuous pull back technique similar to EVL systems.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;What is endovenous laser ablation (EVLA)?&#8221; tab_id=&#8221;1759012899354-da1d8fff-c098e869-cab5&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">What is endovenous laser ablation (EVLA)?<\/h2>\n<p>Endovenous laser treatment is a minimally invasive technique to destroy the greater saphenous vein (GSV) in the thigh and\/or the small saphenous vein (SSV) at the back of the calf.<\/p>\n<p><a href=\"http:\/\/en.wikipedia.org\/wiki\/Laser\" target=\"_blank\" rel=\"noreferrer noopener\">Laser<\/a>\u00a0is an acronym and stands for \u201c<strong>L<\/strong>ight\u00a0<strong>A<\/strong>mplification by\u00a0<strong>S<\/strong>timulated\u00a0<strong>E<\/strong>mission of\u00a0<strong>R<\/strong>adiation.\u00a0 Laser light is monochromatic (single wavelength) light produced from a laser medium and then amplified to produce a powerful beam<\/p>\n<p>There are at least 5 types of laser available all with the supporters and detractors. The different lasers vary in the wavelength of the laser light produced and there are some theoretical advantages and disadvantages of each of these different types of lasers.\u00a0 There is little evidence to support one laser over another and there is no level 1 evidence from blinded randomised trials. Presently there are lasers working at 810, 940, 980, 1320 and 1470nm. EVLT\u2122 is a particular brand of device that is used for EVLA.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;When are RFA\/EVLA used in the treatment of varicose veins?&#8221; tab_id=&#8221;1759014772115-45b909ba-0338e869-cab5&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">When are RFA\/EVLA used in the treatment of varicose veins?<\/h2>\n<p>RFA and EVLA sound impressive, but they are merely alternative techniques that can be used to destroy the greater saphenous vein in the thigh or the small saphenous vein at the back of the calf.\u00a0 RFA or EVLA are alternatives to stripping veins and also replace the disconnection of veins performed through a small incision either in the groin or behind the knee (saphenofemoral and saphenopopliteal disconnection). In sclerotherapy chemical foam is injected to damage the vein. In EVLT and RFA the veins are destroyed by heating them to a high enough temperature to damage the vein wall.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Should I have RFA or EVLA to treat my varicose veins?&#8221; tab_id=&#8221;1759014806183-f54d1997-de0be869-cab5&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">Should I have RFA or EVLA to treat my varicose veins?<\/h2>\n<p>Suitable patients being treated with RFA and EVLA will generally have greater saphenous vein (along thigh) and or small saphenous vein (back of calf) reflux. They will need a vein that is reasonably straight in order to pass the laser fibre or RFA catheter up the vein. It is also important that fluid can be injected around the vein to separate it from the skin and surrounding structures so they do not get burned, but this is a very unlikely event.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Which veins cannot be treated by RFA or EVLA?&#8221; tab_id=&#8221;1759014827533-6ef99622-00a9e869-cab5&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">Which veins cannot be treated by RFA or EVLA?<\/h2>\n<p>Large visible tortuous varicose veins cannot be treated. Thread and reticular veins cannot be treated with RFA or EVLT and are usually best treated with sclerotherapy. Veins being treated need to be reasonably, but not absolutely, straight to enable the catheters to pass.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;How are RFA and EVLA performed?&#8221; tab_id=&#8221;1759014855534-cd1bf395-e355e869-cab5&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">How are RFA and EVLA performed?<\/h2>\n<p>These techniques are very similar but there are some minor differences.<\/p>\n<p>The first part of the procedure involves inserting a catheter (fine tube) into the vein to be treated (cannulation). This is usually done by using ultrasound to guide a fine hollow needle into the vein. A wire is then passed into the vein through the hollow of the needle and the needle removed along the wire.\u00a0 The wire is then passing from outside the skin into the vein.\u00a0 The hollow catheter is then threaded on to the part of the wire on the outside and passed along the wire into the vein.\u00a0 Once the catheter is in position the wire is removed. This is known as the\u00a0<a href=\"http:\/\/en.wikipedia.org\/wiki\/Seldinger_technique\" target=\"_blank\" rel=\"noreferrer noopener\">Seldinger technique<\/a>\u00a0and is a common method of obtaining access to many structures in the body. Ideally the catheter should be positioned down the leg as far as the abnormal flow is present. If necessary a small incision can be made to obtain access to an appropriate vein if this is difficult using the ultrasound technique.<\/p>\n<p>The radiofrequency catheter\/laser fibre is then passed up the vein and positioned no closer than 2cms from the saphenofemoral or saphenopopliteal junctions.\u00a0 These are junctions between the superficial and the deep veins and the distance is to minimise the possibility of damage to the deep veins, but maximise the length of vein to be treated. The video below is an animation of the technique. http:\/\/www.youtube.com\/embed\/JwWlLTzXtdo?rel=0<\/p>\n<p>In both techniques it is essential that the vein being treated is separated from the surrounding tissues by injecting fluid around the vein (ultrasound guided tumescent anaesthesia).\u00a0 This is for two reasons. Firstly if the procedure is being performed under local anaesthetic with the patient awake the injections prevent pain being felt when the vein is being treated. Secondly, both techniques heat the vein and the heat needs to be dispersed without damaging any of the tissues surrounding the vein. The liquid that is injected is usually a very dilute local anaesthetic and large volumes are injected, often up to 300mls of fluid per leg. This is a simple and straightforward process.<\/p>\n<p>This is not a painless procedure and if being performed with the patient awake many practitioners will give patients nitrous oxide (laughing gas) or other inhaled pain killers to minimise discomfort.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Are EVLA and RFA equally successful?&#8221; tab_id=&#8221;1759014887716-648cb14b-0019e869-cab5&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">Are EVLA and RFA equally successful?<\/h2>\n<p>Surgery remains the gold standard (<a href=\"http:\/\/download.journals.elsevierhealth.com\/pdfs\/journals\/1078-5884\/PIIS1078588409004882.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Enzler, 2010<\/a>) against which other techniques must be judged and for the first time a\u00a0<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21725957\" target=\"_blank\" rel=\"noreferrer noopener\">randomised trial<\/a>\u00a0has compared results in a group of 500 patients from Denmark comparing surgery, EVLA, RFA and foam sclerotherapy. At one year all treatments were effective but the highest technical failure rate was in patients undergoing sclerotherapy (16%) with the lowest in the surgery and RFA groups (both at 4.8%). Interestingly the mean pain scores after intervention were highest in the EVLA group and lowest in the RFA group with surgery in between. The mean time off work was between 3 and 4 days. It is clear that surgery and RFA at least are comparable treatments especially when surgeons use tumescent anaesthesia, but rather surprisingly EVLA caused more pain than both.<\/p>\n<p>At present the durability of these procedures in the longer term is unknown. Although EVLA can ablate the GSV (<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16673353\" target=\"_blank\" rel=\"noreferrer noopener\">Sharif et al 2006<\/a>), longer term follow up has not been performed in large numbers of patients (<a href=\"http:\/\/www.surgerynz.com\/page0\/styled-5\/files\/laser-rx-in-vv0027s.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Mundy et al, 2005<\/a>).\u00a0 Consequently, EVLA has not been adequately compared with the gold standard of conventional surgery and results may deteriorate with longer term follow up.\u00a0 There are also many different EVLA lasers on the market all with their own theoretical advantages and proponents and with different working wavelengths. There is reasonable evidence now that RFA particularly with the newer ClosureFast technology is a slightly superior procedure when compared with EVLA. One study using the VNUS ClosureFast\u2122 RFA device demonstrated an over 99% success rate at 2 years.<\/p>\n<p>Neither EVLA or RFA have been shown more effective than surgical techniques when it comes to the medium to long term risk of recurrent varicose veins developing.\u00a0 It is also important to remember that EVLA and VNUS Closure are only a replacement for the high tie and stripping part of conventional surgery.\u00a0In my practice I use radiofrequency ablation with the VNUS Closure device in appropriate patients. This avoids a groin incision and minimises discomfort and deals with the source of the visible veins. The visible veins themselves can either be removed through tiny incisions at the same treatment or be managed with injection treatments at a later appointment. In some patients no further treatments are necessary. When comparing the overall procedure rather than just the success of the GSV obliteration concomitant (at the same time) phlebectomy (removal of the actual visible varicose veins) seems to be better. It reduces the need for secondary procedures and significantly improves quality of life and the severity of venous disease (Carradice, 2009).<\/p>\n<p>Globally, many clinicians are involved in treatment of varicose veins.\u00a0 These include sclerotherapy specialists, dermatologists, appearance medicine practitioners and general surgeons.\u00a0 There is a risk of recurrent varicose veins, whoever is involved in your care and whatever claims they may make.\u00a0 There are two main reasons for this.\u00a0 Firstly the nature of the disease will always put patients at risk of recurrent veins.\u00a0 It is a life-long (probably) inherited tendency and over years new veins can appear whatever the treatment, no matter how carefully performed.\u00a0 Secondly, some techniques if not applied correctly may lead to increased risk of recurrence.<\/p>\n<p>Recurrence rates are difficult to compare because definitions of what constitutes recurrence vary from study to study.\u00a0 For instance if the development of thread veins is considered a recurrence, then the majority of patients will develop recurrent veins.\u00a0 This is because thread veins are so common and present in the majority of people over the age of 50 years. The development of larger veins is less common.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;What are the possible complications of RFA or EVLA?&#8221; tab_id=&#8221;1759454202586-0e882afe-f758&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">What are the possible complications of RFA or EVLA?<\/h2>\n<p><strong>Recurrent varicose veins<\/strong>\u00a0\u2013 there is no treatment for varicose veins which is immune from the possibility of new veins developing. This is because although all the veins that are problematic can be treated it is not possible to remove the underlying tendency to develop varicose veins<\/p>\n<p><strong>Nerve damage<\/strong>\u00a0\u2013 this would be an unusual complication providing the procedure is performed correctly; but occasionally nerves supplying the skin can be heated which may cause some tingling or numbness<\/p>\n<p><strong>Burning<\/strong>\u00a0of the skin or surrounding tissues \u2013 provided plenty of tumescent anaesthesia is used and the procedure performed correctly this is unlikely.<\/p>\n<p>Burning or heat injury to the deep veins is possible but very rare as a number of measures are taken to avoid this problem.<\/p>\n<p><strong>DVT<\/strong>\u2013 one report on VNUS radiofrequency ablation has rather worryingly highlighted a high rate of deep venous thrombosis (16% or 1 in every 6 patients), many of whom required significant intervention (Hingorani AP, Ascher E, Markevich N et al, 2004), but this does not seem to have occurred in other practices.<\/p>\n<p><strong>Failure of the procedure<\/strong>\u00a0 \u2013 in perhaps 1-2 people in every 100, the vein being treated doesn\u2019t completely obliterate following RFA. The procedure can be repeated if necessary.<\/p>\n<p>All of the above complications are also potentially present with open surgery and probably to a slightly greater extent.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;Useful links&#8221; tab_id=&#8221;1759014929506-4e94bf49-783de869-cab5&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2 class=\"wp-block-heading\">Useful links<\/h2>\n<p><a href=\"http:\/\/en.wikipedia.org\/wiki\/Radiofrequency_ablation\">http:\/\/en.wikipedia.org\/wiki\/Radiofrequency_ablation<\/a><\/p>\n<p><a href=\"http:\/\/en.wikipedia.org\/wiki\/EVLT\">http:\/\/en.wikipedia.org\/wiki\/EVLT<\/a><\/p>\n[\/vc_column_text][\/vc_tta_section][vc_tta_section title=&#8221;References&#8221; tab_id=&#8221;1759015003224-6e58c0d1-e0dfe869-cab5&#8243;][vc_column_text css=&#8221;&#8221;]\n<h2>References<\/h2>\n<p><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21725957\" target=\"_blank\" rel=\"noreferrer noopener\">Rasmussen LH, Lawaetz M, Bjoern L, Vennits B, Blemings A, Eklof B. Randomised clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for greater saphenous varicose veins.<\/a>\u00a0Brit J Surg 2011; 98: 1079-87.<br \/>\n<a href=\"http:\/\/download.journals.elsevierhealth.com\/pdfs\/journals\/1078-5884\/PIIS1078588409004882.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Enzler MA, van den Bos RR. A new gold standard for varicose vein treatment?<\/a>\u00a0Eur J Vasc Endovasc Surg 2010; 39: 97-98.<br \/>\n<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/16673353\" target=\"_blank\" rel=\"noreferrer noopener\">Sharif MA et al. Endovenous laser treatment for long saphenous vein incompetence.<\/a>\u00a0Brit J Surg 2006; 93: 831-835<br \/>\n<a href=\"http:\/\/www.surgerynz.com\/page0\/styled-5\/files\/laser-rx-in-vv0027s.pdf\">Mundy L, Merlin TL, Fitridge RA, Hiller JE. Systematic review of endovenous laser treatment for varicose veins.<\/a>\u00a0Brit J Surg 2005; 92: 1189-94.<br \/>\n<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/19283745\" target=\"_blank\" rel=\"noreferrer noopener\">Carradice D, Mekako AI, Hatfield J, Chetter IC. Randomised clinical trial of concomitant or sequential phlebectomy after endovenous laser therapy for varicose veins.<\/a>\u00a0Brit J Surg 2009; 96: 369-375.<br \/>\n<a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/15337880\" target=\"_blank\" rel=\"noreferrer noopener\">Hingorani AP, Ascher E, Markevich N et al. Deep venous thrombosis after radiofrequency ablation of greater saphenous vein: a word of caution.<\/a>\u00a0J Vasc Surg 2004; 40: 500-4.[\/vc_column_text][\/vc_tta_section][\/vc_tta_tour][\/vc_column][\/vc_row]\n<\/div>","protected":false},"excerpt":{"rendered":"<p>[vc_row full_width=&#8221;stretch_row&#8221; content_placement=&#8221;middle&#8221; equal_height=&#8221;yes&#8221; rtl_reverse=&#8221;yes&#8221; remove_bottom_col_margin=&#8221;true&#8221; columns_right=&#8221;yes&#8221; wpex_bg_color=&#8221;#03a3de&#8221; min_height=&#8221;350px&#8221;][vc_column width=&#8221;1\/2&#8243;][\/vc_column][vc_column width=&#8221;1\/2&#8243;][vc_column_text css=&#8221;.vc_custom_1759453922316{padding-top: 20px !important;padding-bottom: 20px !important;}&#8221; color=&#8221;#fefefe&#8221;] Radio Frequency Ablation &amp; Endovenous Laser Ablation for Varicose Veins [\/vc_column_text][\/vc_column][\/vc_row][vc_row css=&#8221;.vc_custom_1759015527111{margin-top: 60px !important;}&#8221;][vc_column][vc_tta_tour controls_size=&#8221;md&#8221; active_section=&#8221;1&#8243;][vc_tta_section title=&#8221;What is radiofrequency ablation (RFA)?&#8221; tab_id=&#8221;1759012899351-dcaaabe1-cd5ce869-cab5&#8243;][vc_column_text css=&#8221;&#8221;]Endovenous laser ablation (EVLA) and Radiofrequency ablation (RFA) are techniques that have become available over the&hellip;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-183","page","type-page","status-publish","hentry","entry","no-media"],"_links":{"self":[{"href":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/index.php\/wp-json\/wp\/v2\/pages\/183","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/index.php\/wp-json\/wp\/v2\/comments?post=183"}],"version-history":[{"count":4,"href":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/index.php\/wp-json\/wp\/v2\/pages\/183\/revisions"}],"predecessor-version":[{"id":233,"href":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/index.php\/wp-json\/wp\/v2\/pages\/183\/revisions\/233"}],"wp:attachment":[{"href":"https:\/\/cmcdeploytwo.co.nz\/vsoanz\/index.php\/wp-json\/wp\/v2\/media?parent=183"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}