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RFA at a Glance

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May 17, 2015

RFA at a Glance |

Endovenous Ablation of Varicose Veins
What is Endovenous Ablation of Varicose Veins?

Endovenous ablation is a minimally invasive treatment that uses radiofrequency or laser energy to burn and close abnormally large veins in the leg, called varicose veins.

Normally blood circulates from the heart to the legs via the arteries and returned through the veins. The veins have one way valves which allows blood to return against gravity. If these valves leak blood pools in the leg veins which enlarge and become varicose.

Endovenous ablation is an image guided procedure that uses heat generated by radiofrequency and laser energy to seal off the faulty veins, diverting blood to the nearby healthy veins to return to the heart.

What are some common uses of the procedure?

Though it may be done for cosmetic reasons it is used to relieve symptoms and prevent complications that are bound to occur at a later stage due to the increasing venous hypertension.

Symptoms are due to the enlarged non-functional veins causing circulatory problems (venous insufficiency) and include:

  • Aching pain
  • Swelling
  • Skin itching or ulcers
  • Discolouration
  • Inflammation (phlebitis)

How should I prepare?

  • Report to the doctor all medications you are taking including herbal drugs.
  • Inform of any allergies to medication.
  • Stop aspirin, NSAID’s or blood thinner well before surgery as advised by the doctor.
  • Wear loose fitting clothes and have someone to drive you back home.

What does the equipment look like?

It is an ultrasound machine, a radiofrequency or laser machine and a RFA or laser probe. The ultrasound machine is a computer with a screen and a transducer that resembles a microphone and is used to look into the body and blood vessels. It shows images of vessels on the screen. The catheter is a long thin plastic tube as thick as a strand of spaghetti. These fibres carry laser or electrical energy from the machine to the body.

How does the procedure work?

Using ultrasound to visualize the enlarged vein, a catheter or sheath is passed through the skin into the target vein. This probe is then advanced to the desired location. Laser or radiofrequency energy is applied, heating the vessel and causing it to shut. Following the procedure the target vein will shrink and ‘scar down.’

How is the procedure done?

Image-guided minimally invasive procedures like endovenous ablation are done specially by trained Vascular Surgeons. The procedure is done as a day case though some cases may need admission into the hospital. The site where the catheter is introduced is numbed by local anesthetic to reduce the discomfort. Then he will place the catheter into the target vein by ultrasound guidance. Once in the vein the catheter tip is positioned 2-3 cm from the SF junction valve in the groin under ultrasound guidance. Local anesthetic is injected around the abnormal vein using ultrasound guidance. Laser or radiofrequency energy is applied as the catheter is withdrawn slowly. A crape bandage is applied to the leg to stop bleeding. No sutures are needed. The procedure takes about one hour.

What is experienced during the procedure?

You may be asked to wear laser glasses.
The leg will be cleaned and shaved.
There will be a slight pin prick when the local anesthetic is injected and the site will become numb.
One may feel the introduction of catheter but no serious discomfort.
Injection of local anesthetic around the vein is the most discomfortable and needs multiple injections. The delivery of laser or radiofrequency in the vein is not painful.
After the procedure compression stocking are needed to reduce bruising, tenderness and DVT.
Resume normal activity immediately avoiding air travel or prolonged sitting like long car journey. Activity is a must as sedentary life promotes complications.

What is done in the follow-up?

Within one week the treated vein must be successfully closed. Additional procedure like sclerotherapy or phlebectomy may be needed to treat associated veins.

What are the benefits vs risks?

Benefits:

  • No surgical incision but a small nick in the skin which does not need a stich.
  • Compared to conventional surgery (high tie + stripping) endovenous ablation is more effective, has fewer complications and has less pain during recovery.
  • RFA is complication free and safe.
  • There are no scarsIt is a less invasive altenative to standard surgery.
  • Treated veins are invisible to ultrasound within 12 months of procedure.Most patients has symptomatic relief and return to normal activity immediately with little or no pain.

Risks:

  • Any procedure with skin puncture carries risk of infection and the need for antibiotics is 1: 1000.
  • There is a very small risk of placement of catheter into the target vein which may damage the vein and cause bruising or bleeding at the puncture site.
  • Some post operative bruising and tenderness may occur but relieved by compression stockings.
  • Some cases of thermal nerve damage has been reported but always goes away over a short time.
  • Thrombophlebitis (inflammation of vein) is seen and causes pain and redness. It responds to NSAIDs.
  • Blood clots formed in the veins may extend to the deep veins and travel to the lungs (pulmonary embolism). This is extremely rare.

What are the limitations of endovenous ablation?

Ablation catheters cannot pass through veins with lots of turns and bends (tortuous) and so this procedure is mostly used for long saphenous vein. This technique is 100% successful in closing the target vein but perforators may persist and need sclerotherapy or phlebectomy as an additional procedure at a later stage.

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