Comparison of Post-operative Pain after Segmental Radiofrequency Ablation (VNUS ClosureFAST) and Endovenous Laser Ablation using 810nm bare tip fibre for the Treatment of Primary Great Saphenous Vein Reflux

P. Marsh, B.A. Price, J.M. Holdstock, C. Harrison, C. Smith, M.S. Whiteley
The Whiteley Clinic, Stirling House, Stirling Road, Guildford, Surrey GU2 7RF
Endovenous thermoablative techniques are gaining popularity in the treatment of varicose veins.  Segmental radiofrequency ablation (RFA) has recently been introduced as an option using local anaesthesia. The aim of this study was to compare the post-operative pain profiles of segmental RFA (VNUS™ ClosureFAST™) and endovenous laser ablation (EVLA) using an 810nm diode laser with a bare tip fibre.
Materials & Methods:
A prospective audit of patients undergoing primary surgery for refluxing great saphenous veins (GSV) with EVLA or segmental RFA under LA in a single centre was carried out.  Post-operative pain was recorded using visual analogue scales and results for each group were compared.
During the period, 19 limbs were treated with EVLA and 19 with segmental RFA alone. Of these, 29 diaries were returned for analysis (13 EVLA and 16 segmental RFA). Pain scores were significantly lower on days 1-6 in the segmental RFA group (P0.003).  Analgesic use was also significantly less, as were scores for activity and mobility on days 1-3 (P<0.05).  Bruising was reduced on days 1-5 but this was not significant. Early vein occlusion rate was 100% for both groups. Post-segmental RFA, one heat-induced thombosis occurred and one GSV required immediate repeat ablation. No complications occurred in the EVLA group.
Segmental RFA with VNUS Closure FAST appears to have a favourable post-operative pain profile compared with EVLA using an 810nm diode laser with a bare tip fibre.