EVLA stands for Endovenous Laser Ablation, and RFA stands for Radio Frequency Ablation. These are the 2 main modalities of non-surgical, minimally invasive treatment of varicose veins. What does all of this mean?
Let’s start from the beginning. The vein wall has three layers. The inner layer of the vein wall is known as the Tunica Intima. This is a thin lining of cells that prevents the blood from clotting. If this lining is destroyed, the blood will clot. An example of this is when a person gets a cut. The cut interrupts the intact Tunica Intima and the blood as a response clots around that particular interruption of the inner lining. Over time, skin heals and the lining grows again and blood starts to flow
EVLA (Endovenous Laser Ablation) and RFA (Radio Frequency Ablation) use the similar principle. Heat is generated from the radiofrequency catheter in RFA and the laser fiber in EVLA to burn this layer of endothelium. When the layer of endothelium is burnt, the vein cannot stay open and it clots. Usually, the heat is sufficient to burn the middle layer of the vein (known as Tunica Media). The RFA catheter generates controlled heat at a target temperature of 120 degrees C. This is achieved by passing electrical current through ions. The ions shake and the friction causes generation of heat. In EVLA the laser fiber produces heat using monochromatic light. The temperature can rise up to 700 degrees C. EVLA comes in many wavelengths of light ranging from wavelengths of 890-1470. Laser manufacturers claim 1470 cause less post procedure discomfort, but in our experience there is not much difference in pain by the different frequencies of Laser. In peer reviewed published data, it is generally recognized that the RFA or Radiofrequency Ablation (now marketed as the Venefit procedure) causes significantly less post procedural discomfort than EVLA.
It is also widely known that most free standing clinics that perform EVLA re-use and perform in office re-sterilization of their Laser fibers (up to 5 times). This reduces the effectiveness of laser and increases the chance of potential infection. Re-sterilization in free standing clinics is as good as the person re-sterilizing the equipment. In addition, laser fibers are generally cheaper (the savings are not passed on to the patients) than RFA catheters and have a risk of breaking during the procedure, especially if proper care is not done when re-sterilizing the laser fiber and after multiple uses. The RFA catheters, on the other hand, are much sturdier and if a clinic wants to re-sterilize the catheters they have to send them to a company in the Minneapolis St Paul Twin City Area called VascularSolutions. Vascular Solutions has a free standing, independent site that evaluates catheter quality and re-sterilizes at a cost that makes it an ideal option for green initiatives. At Metro Vein Clinic we use RFA (Venefit ) as main modality of treatment along with sclerotherapy. We do have the ability to perform EVLA, but we refuse to re-sterilize laser fibers. Metro Vein Clinic PA is a site for training on EVLA for Vascular Solutions and Covidien (the maker of VNUS i.e. the RFA or the Venefit procedure) in the Minneapolis St Paul Twin Cities Area. It is a good idea to ask your provider if they re-sterilize laser fibers at their facilities or not.