Is radiofrequency ablation of varicose veins a valuable option? A systematic review of the literature with a cost analysis

Abstract

Background: Since the 1990s, new techniques for the treatment of varicose veins have emerged, including radiofrequency ablation (RFA) and laser treatment. We performed a study to compare the safety, efficacy and outcomes of RFA compared to those of open surgery and laser ablation for the treatment of varicose veins. We also carried out a cost analysis of RFA compared to open surgery to assess whether RFA could help free up operating room time by being performed in an outpatient context. Methods:We conducted a systematic literature review (publication date May 2010-September 2013 for articles in English, January 1991-September 2013 for those in French). We used several checklists to measure the quality of the studies. We also collected data on costing. Results:The literature search identified 924 publications, of which 38 were retained for analysis: 15 literature reviews, 1 good-practice guideline and 22 new primary studies. The overall level of evidence was low to moderate owing to the limited sample sizes, lack of information on patient characteristics and lack of standardization of the outcome measures. However, the results obtained are consistent from study to study. In the short and medium term, RFA is considered as effective as open surgery or laser treatment (moderate level of evidence) and presents fewer major and minor complications than open surgery (low level of evidence). Radiofrequency ablation can be performed on an outpatient basis. We calculated that RFA would be about $110-$220 more expensive per patient than open surgery. Conclusion:Radiofrequency ablation is a valuable alternative to open surgery and would free up operating room time in a context of low accessibility.

The Effectiveness of Endovenous Radiofrequency Ablation Application in Varicose Vein Diseases of the Lower Extremity

“…Studies on this topic unanimously report that, regardless of treatment method, the outcome is very favorable and venous symptoms are almost completely resolved with treatment [14][15][16].…”

Radiofrequency Ablation Therapy for Varicose Veins Guided By Ultrasound: Overview and Preliminary Experience

“…As of 1990 there are scientific works that demonstrate that the RFA is a safe and effective method to abolish the reflux of the saphenous vein [15], as described by Merchant RF, et al in which complete improvement of saphenous vein insufficiency is reported greater with RFA (between 90 and 100%) of the cases, making follow-ups between three months and four years [14,16]. RFA equals conventional surgery in efficacy but it is also clearly superior in terms of less postoperative pain, better quality of life and faster recovery [17,18].…”

Varizenchirurgie: Belastender als andere Verfahren?

“…Studien und Publikationen zu dem Risiko postoperativer tiefer Beinvenenthrombosen nach endovenösen thermischen Ablationen, beschreiben ein Thromboserisiko von ca. 1-1,8 % [11][12][13]. Das ist ein deutlich höheres Thromboserisiko als nach der klassischen operativen Sanierung der Varikosis.…”

“…In der Publikation von Poder et al wird das Infektionsrisiko der endovenösen Radifrequenzablation mit 0,4 % angegeben [13]. Weitere Literaturangaben zum Infektionsrisiko bei endovenösen Verfahren und Sklerosierungsbehandlung sind schwer zu finden.…”