Radio-frequency ablation vs. open surgery in the treatment of varicose veins - a comparative study

Abstract

Background: Varicose veins are common and often debilitating. Radio-frequency ablation (RFA) has emerged as a minimally invasive alternative to open venous ligation surgery (OVL). It has been shown to reduce peri-operative morbidity and improves quality of life scores. Aim: The aim of the study was to directly compare RFA and OVL. Methods: This was a single centre retrospective cohort study. All patients with confirmed sapheno-femoral junctional incompetence who underwent surgical management between January 2011 and December 2012 were included. Radiological success, choice of anaesthesia and hospital length of stay (LOS) was documented. Procedural cost was also calculated. Focused cohort analysis was undertaken to compare the initial 50 RFA procedures performed with the last 50. This allowed for departmental learning curve assessment over a 12-month period. Results: During the study period 298 patients underwent surgical intervention. A total of 204 patients had RFA. When compared RFA was associated with a reduction in the requirement for general anaesthesia (41 % vs 100 %, P = 0.000), overnight hospital stay (22 % vs 82 %, P = 0.000) and pre-operative blood tests (5 % vs 38 %, P = 0.000). RFA success rate was 98 %. Thirty-day readmission rates were similar (p = 0.203). OVL cost was significantly less than RFA (884 vs 1102, p =<0.001). RFA subgroup analysis identified increased use of intravenous sedation (18 % v 60 %) and reduction in overnight hospital stays (10 % vs 36 %) over the 12-month period. Conclusion: RFA is a viable alternative to OVL, requiring less invasive anaesthesia, fewer laboratory tests and reduced LOS. However, it is associated with a higher financial cost.