Varicose veins of the lower limbs are a common manifestation of chronic venous insufficiency, characterized by dilated, tortuous superficial veins resulting from venous valvular incompetence and reflux. Patients frequently experience pain, heaviness, swelling, itching, and cosmetic concerns, which may significantly affect their quality of life. Advances in minimally invasive treatment have improved clinical outcomes and reduced postoperative morbidity [1]. Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) have emerged as effective alternatives to conventional surgical ligation and stripping. Both techniques achieve venous closure through thermal injury to the vein wall, resulting in fibrosis and subsequent occlusion. Although both procedures demonstrate high technical success rates, differences have been reported in postoperative pain, bruising, recovery time, and complications [2,3]. Recent comparative studies and meta-analyses have demonstrated comparable efficacy between EVLA and RFA in achieving venous occlusion and symptomatic improvement. However, variations in thermal energy delivery may influence postoperative discomfort, nerve injury, and recurrence rates [4]. Current clinical guidelines recommend endovenous ablation for symptomatic superficial venous reflux because of its effectiveness, minimally invasive nature, and favorable recovery profile [5]. Long-term treatment success depends on sustained venous occlusion, improvement in clinical severity, and prevention of recurrent varicosities. Previous investigations have highlighted differences in recurrence patterns and anatomical outcomes following EVLA and RFA [6]. Standardized duplex ultrasonography and clinical severity assessment are essential for evaluating treatment effectiveness and identifying postoperative complications [7]. Therefore, the present study aimed to compare the clinical outcomes, postoperative complications, and recurrence rates following EVLA and RFA in patients with lower limb varicose veins.

Study Design and Setting This prospective comparative observational study was designed to evaluate the clinical outcomes of EVLA and RFA in patients with lower limb varicose veins. The study included 100 patients over a duration of two years at a tertiary care hospital. Study Population A total of 100 patients with symptomatic lower limb varicose veins and duplex-confirmed superficial venous reflux were included. Patients were divided into two groups according to the treatment received: • Group I (EVLA): 50 patients treated with endovenous laser ablation. • Group II (RFA): 50 patients treated with radiofrequency ablation. Inclusion Criteria Patients aged 18 years or older with symptomatic lower limb varicose veins, clinically significant superficial venous reflux confirmed by duplex ultrasonography, and suitability for endovenous thermal ablation were included. Exclusion Criteria Patients with acute deep vein thrombosis, severe peripheral arterial disease, active systemic infection, pregnancy, previous intervention involving the target vein, or contraindications to endovenous thermal ablation were excluded. Preoperative Assessment All patients underwent detailed clinical evaluation, including demographic characteristics, medical history, presenting symptoms, and physical examination. Disease severity was assessed using the Clinical–Etiological–Anatomical–Pathophysiological (CEAP) classification and Venous Clinical Severity Score (VCSS). Duplex ultrasonography was performed to evaluate venous reflux, vein diameter, anatomical involvement, and deep venous patency. Treatment Procedure Group I – Endovenous Laser Ablation (EVLA): Patients underwent ultrasound-guided venous cannulation followed by insertion of a laser fiber into the incompetent superficial vein. Tumescent anesthesia was administered around the target vein, and controlled laser energy was delivered during fiber withdrawal to achieve thermal closure. Group II – Radiofrequency Ablation (RFA): Patients underwent ultrasound-guided venous access and placement of a radiofrequency catheter. Following administration of tumescent anesthesia, controlled radiofrequency energy was applied to the incompetent vein segments to produce thermal injury and venous occlusion. Following both procedures, compression therapy and early ambulation were advised according to institutional protocol. Outcome Assessment and Follow-up Patients were evaluated for procedural success, postoperative pain using the Visual Analogue Scale (VAS), bruising, ecchymosis, skin burns, paresthesia, superficial thrombophlebitis, deep vein thrombosis, and time required to resume normal activities. Clinical improvement was assessed through changes in VCSS. Duplex ultrasonography was used to evaluate venous occlusion, recanalization, and recurrence. Follow-up assessments were scheduled at 1 month, 3 months, 6 months, and 12 months, with subsequent evaluation up to 24 months when available. Statistical Analysis Data were entered into Microsoft Excel and analyzed using IBM SPSS Statistics version 25.0. Continuous variables were expressed as mean ± standard deviation, while categorical variables were presented as frequencies and percentages. The independent-samples Student's t-test or Mann–Whitney U test was used to compare continuous variables between groups, depending on data distribution. The Chi-square test or Fisher's exact test was applied to categorical variables. Changes in VCSS were evaluated using paired statistical tests, while recurrence-free outcomes were assessed using Kaplan–Meier survival analysis when follow-up data permitted. A p-value <0.05 was considered statistically significant. Ethical Considerations The study was conducted in accordance with institutional ethical standards.

A total of 100 patients with symptomatic lower limb varicose veins were included in the study. Patients were divided equally into Group I (EVLA, n=50) and Group II (RFA, n=50). Baseline demographic and clinical characteristics were comparable between the groups. Both procedures demonstrated favorable clinical outcomes, with differences in postoperative pain, recovery time, and certain complications. Table 1. Baseline Demographic and Clinical Characteristics Parameters EVLA (n=50) RFA (n=50) p-value Mean age (years) 43.8 ± 11.6 45.2 ± 10.9 0.535 Male 32 (64.0%) 30 (60.0%) 0.680 Female 18 (36.0%) 20 (40.0%) 0.680 BMI (kg/m²) 26.4 ± 3.8 26.8 ± 4.1 0.614 Duration of symptoms (months) 28.6 ± 12.4 30.2 ± 13.1 0.532 CEAP C2 24 (48.0%) 22 (44.0%) 0.688 CEAP C3 18 (36.0%) 19 (38.0%) 0.836 CEAP C4–C5 8 (16.0%) 9 (18.0%) 0.790 Baseline VCSS 8.4 ± 2.1 8.6 ± 2.3 0.651 Baseline demographic characteristics, clinical severity, and duration of symptoms were comparable between the EVLA and RFA groups (p>0.05). Table 2. Comparison of Procedural and Clinical Outcomes Parameters EVLA (n=50) RFA (n=50) p-value Procedural duration (minutes) 48.6 ± 10.4 42.2 ± 9.6 0.002 Technical success 49 (98.0%) 50 (100%) 1.000 Postoperative VAS score (24 hours) 3.8 ± 1.2 2.6 ± 1.1 <0.001 Analgesic requirement 29 (58.0%) 18 (36.0%) 0.028 Hospital stay (hours) 18.4 ± 5.6 16.2 ± 4.8 0.037 Return to normal activities (days) 5.8 ± 1.9 4.2 ± 1.5 <0.001 VCSS at 6 months 2.6 ± 1.3 2.2 ± 1.1 0.100 Complete venous occlusion at 6 months 47 (94.0%) 48 (96.0%) 1.000 Both procedures demonstrated high technical success and favorable clinical improvement. RFA was associated with shorter procedural duration, lower postoperative pain, reduced analgesic requirements, and earlier return to normal activities (p<0.05). Table 3. Comparison of Postoperative Complications Complications EVLA (n=50) RFA (n=50) p-value Ecchymosis/bruising 12 (24.0%) 5 (10.0%) 0.062 Postoperative pain requiring additional medication 14 (28.0%) 6 (12.0%) 0.046 Skin burns 3 (6.0%) 1 (2.0%) 0.617 Paresthesia 5 (10.0%) 2 (4.0%) 0.436 Superficial thrombophlebitis 4 (8.0%) 2 (4.0%) 0.678 Deep vein thrombosis 1 (2.0%) 0 (0.0%) 1.000 Wound infection 2 (4.0%) 1 (2.0%) 1.000 Postoperative complications were generally infrequent in both groups. Pain requiring additional medication was more frequent following EVLA (28.0%) than RFA (12.0%; p=0.046). Other complications showed no statistically significant differences. Table 4. Venous Occlusion, Recanalization, and Recurrence Outcome parameters EVLA (n=50) RFA (n=50) p-value Complete occlusion at 1 month 49 (98.0%) 50 (100%) 1.000 Complete occlusion at 6 months 47 (94.0%) 48 (96.0%) 1.000 Complete occlusion at 12 months 46 (92.0%) 47 (94.0%) 1.000 Recanalization at 12 months 4 (8.0%) 3 (6.0%) 1.000 Clinical recurrence at 12 months 5 (10.0%) 4 (8.0%) 1.000 Symptomatic improvement at 12 months 45 (90.0%) 47 (94.0%) 0.715 Patient satisfaction 44 (88.0%) 46 (92.0%) 0.741 Both EVLA and RFA demonstrated favorable venous occlusion and symptom improvement at 12 months. Recurrence was slightly higher following EVLA (10.0%) than RFA (8.0%), although the difference was not statistically significant (p>0.05).

The present comparative study evaluated the clinical outcomes, postoperative complications, and recurrence following endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in 100 patients with lower limb varicose veins. Both procedures demonstrated high technical success rates and substantial clinical improvement. However, RFA was associated with reduced postoperative pain, shorter procedural duration, and earlier recovery compared with EVLA. In the present study, technical success was achieved in 98% of EVLA patients and 100% of RFA patients, with no statistically significant difference (p=1.000). These findings were consistent with Kempeneers et al. [8], who demonstrated favorable anatomical and clinical outcomes following both endovenous thermal ablation techniques. Similarly, Mohammadi Tofigh et al. [9] reported comparable treatment effectiveness between EVLA and RFA, supporting their use as minimally invasive alternatives for superficial venous incompetence. Postoperative pain was significantly lower following RFA (2.6 ± 1.1) compared with EVLA (3.8 ± 1.2; p<0.001). Patients undergoing RFA also experienced reduced analgesic requirements and faster recovery. Hamann et al. [10] similarly observed greater postoperative discomfort and adverse events following EVLA compared with radiofrequency techniques. Brittenden et al. [11] demonstrated sustained clinical benefits following minimally invasive treatment of varicose veins, emphasizing the importance of long-term patient-reported outcomes. Postoperative complications, including bruising, paresthesia, skin burns, and superficial thrombophlebitis, were generally more frequent in the EVLA group, although most differences were statistically insignificant. Eroglu and Yasim [12] reported favorable clinical outcomes with endovenous ablation techniques, while Woźniak et al. [13] highlighted the importance of monitoring complications and treatment failure during long-term follow-up. At 12 months, complete venous occlusion was observed in 92% of EVLA patients and 94% of RFA patients (p=1.000). Clinical recurrence occurred in 10% and 8% of patients, respectively, without a statistically significant difference. These findings suggest comparable short-term anatomical effectiveness. Previous investigations have also demonstrated the clinical effectiveness of endovenous treatment, although long-term recurrence remains an important consideration [14]. Clinical severity improved substantially in both groups, as reflected by reductions in Venous Clinical Severity Score (VCSS). Standardized clinical assessment using the CEAP classification and validated severity measures remains essential for evaluating disease progression and treatment outcomes [15]. The principal limitations of this study included the relatively small sample size, observational design, and limited duration of follow-up. Larger randomized studies with standardized procedural techniques and longer follow-up are required to establish differences in long-term recurrence and treatment durability.

Both EVLA and RFA demonstrated favorable clinical outcomes and high venous occlusion rates in patients with lower limb varicose veins. RFA was associated with significantly lower postoperative pain, reduced analgesic requirements, and faster recovery. However, venous occlusion and recurrence rates were comparable between the two procedures. RFA may offer advantages in early postoperative recovery, while both techniques remain effective minimally invasive treatment options.

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