Endovenous laser ablation versus radiofrequency ablation in chronic venous insufficiency: a comparative meta-analysis of efficacy and safety

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Background Chronic venous insufficiency (CVI) is a common vascular disorder that substantially impairs quality of life. Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) have largely replaced conventional surgery; however, their comparative efficacy and safety—particularly across follow-up time points and EVLA wavelengths—remain debated. Methods We conducted a systematic review and meta-analysis of PubMed, Scopus, Web of Science, the Cochrane Library, and Google Scholar from inception to September 2024. Thirty-three comparative studies (9 randomized controlled trials and 24 non-randomized studies) involving 22,814 patients (8,144 EVLA and 14,670 RFA) were included. Analyses were performed at the patient level. The single primary outcome was complete occlusion of the treated vein; all other endpoints were secondary. Secondary outcomes included procedural success, recanalization, partial occlusion, reflux-free rate, postoperative pain, recurrence, return to work or daily activities, patient satisfaction, and complications, with stratified analyses by follow-up time and EVLA wavelength. Results RFA was associated with significantly lower postoperative pain at 6 weeks (mean difference [MD] = −3.00; 95% CI: −3.42 to −2.58) and 6 months (MD = −1.00; 95% CI: −1.85 to −0.14), and a reduced risk of paresthesia at 1 month (odds ratio [OR] = 0.52; 95% CI: 0.28–0.95). Non-randomized studies suggested lower recurrence rates with RFA compared with EVLA (OR = 0.42; 95% CI: 0.29–0.62), although randomized trials showed no significant difference. Complete occlusion rates were lower with RFA than with EVLA in pooled analyses (OR = 0.07; 95% CI: 0.04–0.14), particularly at early follow-up (1 day: OR = 0.01; 95% CI: 0.00–0.11), with differences diminishing over time. Variation in outcome definitions and imaging timing likely contributed to these early effects. Reflux-free rates and patient-reported outcomes, including Aberdeen Varicose Vein Questionnaire scores, did not differ significantly between groups. Conclusion Both EVLA and RFA are effective and safe treatments for CVI. RFA provides advantages in short-term postoperative comfort and selected complications, whereas EVLA—particularly with 1,470-nm wavelengths—achieves more consistent early technical occlusion. However, these differences do not translate into clear differences in reflux-free status or patient-reported quality-of-life outcomes, supporting individualized treatment selection. When performed competently, neither modality offers a clinically meaningful advantage for patient-centered outcomes.

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