Radiofrequency ablation or laser?

What radiofrequency ablation actually is

Radiofrequency ablation is a way of closing a varicose vein from the inside using heat. A thin catheter is passed into the failed vein through a single puncture, positioned with ultrasound, and radiofrequency energy heats the vein wall until it contracts and seals. The blood then reroutes through the healthy deep veins it should have been using all along.

Endovenous laser does the same job with a different energy source. Instead of a radiofrequency catheter, a thin fibre delivers laser light, and the heat from that light closes the vein wall in the same way.

Both belong to the same family, which doctors call endothermal ablation. That shared name matters more than the difference between them, and it is why the guidance treats them together.

What they have in common, which is most of it

Reading about them separately makes them sound like rival products. In the clinic they are close to interchangeable. Both go in through one puncture. Both are placed under ultrasound. Both use local anaesthetic with a ring of dilute anaesthetic placed around the vein, which is what makes the procedure comfortable and protects the tissue nearby. Neither needs a general anaesthetic, neither needs a hospital bed, and after both you walk out and are asked to keep walking.

Both treat the same thing: a trunk vein whose valves have failed, letting blood fall back down the leg. And neither treats spider veins, which are far too small for a catheter or a fibre and are closed with a fine injection instead.

So which one is better?

This is the question patients arrive with, and the honest answer is unsatisfying: for most legs, the choice between them is not what decides your result.

Published comparisons of the two put them close together on the outcome that matters, which is whether the vein stays closed. Some studies have reported less bruising or discomfort in the first days after radiofrequency; others have found the gap narrow or absent, and newer laser wavelengths and fibres have moved the comparison again. National guidance reflects this: the United Kingdom's NICE guideline CG168 recommends endothermal ablation as the first choice for a confirmed failing trunk vein, and does not pick radiofrequency over laser or laser over radiofrequency. It recommends the category, because the evidence supports the category.

What does change the result, considerably: whether the duplex scan correctly identified which vein is actually failing, whether the whole failing segment was treated rather than part of it, and whether the branches feeding it were dealt with afterwards. A vein treated with the wrong plan will not stay closed no matter which energy source was used.

What I use, and why I am telling you this

I perform endovenous laser. I do not offer radiofrequency ablation, and this page is not an argument that laser is superior, because I do not believe the evidence supports that claim in either direction.

I have written it because patients come in having read that one is better than the other and expect me to defend a position. The useful thing to know before you choose anyone is that this is not the question to interview a doctor about. Ask instead what the scan showed, which vein is being treated and why, what happens to the branches, and what the plan is if part of it reopens. Those answers tell you far more than the name of the device.

And for a great many legs the question never arises, because there is no failed trunk vein to ablate at all and the problem is treated with injections.

What either procedure involves

Expect mild bruising along the treated vein for one to two weeks, a feeling of tightness or pulling along its line as it heals, and a compression stocking for a short period afterwards. Every procedure carries some risk: bruising, temporary pigmentation along the vein, numbness in a small patch of skin, and less commonly inflammation of the vein. Thermal ablation of a trunk vein carries a small risk of a clot extending toward the deep system, which is why the leg is scanned again afterwards. All of it is discussed with you in person, before anything is decided.