Radiofrequency Ablation Therapy for Varicose Veins

Venous insufficiency resulting from superficial reflux because of varicose veins is a serious problem that usually progresses inexorably if left untreated. When the refluxing circuit involves failure of the primary valves at the saphenofemoral junction, treatment options for the patient are limited, and early recurrences are the rule rather than the exception.

Endovenous ablation has replaced stripping and ligation as the technique for elimination of saphenous vein reflux. One of the endovenous techniques is a radiofrequency-based procedure.

Endovenous procedures are far less invasive than surgery and have lower complication rates. The procedure is well tolerated by patients, and it produces good cosmetic results.

Endovenous techniques (endovenous laser therapy, radiofrequency ablation, and endovenous foam sclerotherapy) clearly are less invasive and are associated with fewer complications compared with more invasive surgical procedures, with comparable or greater efficacy.

Technology

The original radiofrequency endovenous ablation system worked by thermal destruction of venous tissues using electrical energy passing through tissue in the form of high-frequency alternating current. This current was converted into heat, which causes irreversible localized tissue damage. Radiofrequency energy is delivered through a special catheter with deployable electrodes at the tip; the electrodes touch the vein walls and deliver energy directly into the tissues without coagulating blood.

Technique

Radiofrequency ablation catheters cannot be easily passed along a tortuous superficial vein; therefore, the procedure is principally of use in the treatment of truncal varicose veins, such as the great saphenous vein. Radiofrequency ablation is also used with small saphenous vein incompetence.

The leg is prepared and draped, and a superficial local anesthetic agent is used to anesthetize the site of cannulation. With ultrasonographic guidance, a local anesthetic agent is injected into the tissues surrounding the great saphenous vein above and within its fascial sheath. Duplex ultrasonography is used to position the catheter tip in desired point. In the new system, when the radiofrequency is activated, the catheter core temperature should rapidly rise to 120ºC and should be sustained for 15 seconds of the 20-second pulse cycle.

Complications

Reported complications of the procedure are rare. Local paresthesias can occur from perivenous nerve injury but are usually temporary. Thermal injury to the skin was reported in clinical trials when the volume of local anesthetic was not sufficient. The greatest current area of concern is deep vein thrombosis which has been rare in our experience.