Radiofrequency ablation (RFA)
Radiofrequency ablation (RFA) or obliteration of saphenous veins is one of the latest and safest treatment for varicose veins of lower limbs. It was developed 15 years ago and has become widespread in Russia, Western Europe, USA and other countries. This method was brought to phlebology from cardiosurgery, which has been being widely applied until the present to restore normal heart rhythm by its influence on offending areas of cardiac conduction.
Radiofrequency ablation of saphenous veins is based on application of microwaves, which warm up the vein wall, producing irreversible changes in it, which results in obliteration of lumen and it (the vein wall) doesn’t exist as a vascular structure any more. According to its safety and efficiency the method corresponds to laser coagulation, but it differs from it by its simplicity in performance and patients experience less pain after the operation. High cost disposable catheters (electrodes) are used during the procedure, but such advantages as painlessness and a short term of wearing of compression garments compensate these expenses.
Radiofrequency ablation of lower limb veins has replaced «the traditional» or open surgical interventions (with incisions) and is applied in patients with different forms of varicosity in cases large saphenous veins are damaged. The operation is performed in ambulatory surgery centers (without a hospitalization), under local anesthesia, it is bloodless, painless, it doesn’t require any incisions and sutures, it doesn’t have age restrictions, it can be performed even in cases of severe varicosity. The main peculiarity of the operation is a quick (particularly instantaneous) recovery time that makes this method so popular not only among phlebologists, but also among patients.
How is the procedure performed?
The procedure is performed under local anesthesia, with the help of ultrasound control. During the procedure a simple radiofrequency electrode (catheter with microwave emitter) is introduced into a varicose vein lumen by its puncture. As the varicosity affects the whole saphenous vein – from its initial part (near malleolus) to its return to the deep vein ( pelvic area, or popliteal region), so the catheter is inserted through the whole vein to its ending. When the doctor makes sure that the position of radiofrequency catheter in vein is a right one, he starts to form a hydraulic «pillow» around the vein through the whole part of the vein that has been changed. To do this, using a special pump, the doctor introduces 1 liter of water solution with anesthetic into the area between the skin and vein from one side and the vein and deep tissues — from another. As a result, the surgeon achieves two goals: makes an ideal local anesthesia and separates vein from nearby tissues.
After the signaling from the generator of radiofrequency radiation to the electrode its ultimate working part with the length of 7 sm is warming up till 120 degrees. At such a temperature the vein wall which surrounds catheter is also getting warm. This leads to denaturation of blood proteins and vein wall, or in other words, to irreversible burns of all panniculuses of varicose vein wall. The vein wall is «welded up» from the inside.
Moving through the superposed to subjacent vein segment, removing catheter from the vessel, a doctor «welds up» the whole vein segmentally. Small vein branches, entering the main vein, damaged by high temperature, are extracted from punctures by the doctor with the help of special hooks, or if it is simplier to say – he makes the veins sclerorised (a medicamentous drug in the form of foam is being introduced into the vein).
In case of evident varicosity the procedure can be divided into two stages. During the first stage a doctor «welds up a large branch of varicose vein”, during the second stage he performs the whole procedure of foam sclerotherapy on small veins under ultrasound control.
Hereinafter, affected veins don’t participate in the bloodstream, nearby healthy vessels start to function instead of them.
At the end of the procedure a special compression stocking is put on the leg and the patient leaves a healthcare establishment independently. The procedure takes from about 30 minutes to 1 hour.
What is the advantage of the new method?
- Accuracy, effectiveness and maximal safety of the procedure
- High cosmetic effect (without any incisions and scars)
- Possibility to use it in combination with other methods (sclerotherapy)
- Unnecessity in general anesthesia or spinal anesthesia, used in traditional surgical treatment.
Outpatient healthcare is carried out when a patient can stay at home and continue his work. There is only one day given for recovery. The next day a patient gets down to work (if it is not a rough labour).
In comparison with an analogic procedure widely applied in Minsk – vein laser coagulation, radiofrequency method is technically simpler: radiofrequency generator is equipped with the feedback system and automatically selects and chooses an optimal radiation power for every single case. Besides, at postoperative period such manifestations as soreness and soft tissues oedema are minimally evident, and side effects such as hematomas and hemorrhage are not even registered. In comparison with the laser, radiofrequency ablation is characterized by more «gentle» influence on the vein wall and nearby tissues.
Unlike foam sclerotherapy of large veins, performed under ultrasound control (which is such effective as other modern treatment methods of varicosity) and demanding multiple treatment sessions (to 5 — 6 sessions to each leg), radiofrequency method is a one-time performed procedure.
Postoperative period
A patient can leave an operative room by himself, without any help. He doesn’t need any anesthesia. Practically, there are not any incisions during the procedure, so there are not any bleedings. As a rule, it is possible to get down to work the next day. Sports activities are permitted in a week to avoid disease recurrence. A patient recovers in 2-4 weeks.
There are not any bruises and swellings after the procedure. It is necessary to wear compression garments for 5-14 days, taking them off before sleep.
Who needs the procedure?
Indications for the procedure include chronic vein diseases – primary varicosity, venous dilation after thrombosis of deep veins, and also some forms of congenital defects of venous system of lower limbs. The procedure has proven its efficiency also in the treatment of recurrent varicosity – appearance of varicose veins after other operations and procedures which treat varicosity.
Who determines the necessity of the operation and how he does it
A phlebologist selects patients for radiofrequency ablation on the basis of clinical examination and results of venous ultrasound. A doctor who performs radiofrequency ablation can perform ultrasound of veins and is able to do examination by himself. Due to ultrasound a doctor gets information about the parameters of varicose vein: its diameter and position at different levels of the limb, peculiarities of its return to the deep vein, presence of varicose veins and their diameter. In a word, a doctor needs correct information about the anatomy of veins of a concrete patient and its changes due to the disease.
Contraindications to the procedure
The operation is not performed in cases of acute thrombophlebitis – inflammations in the interested area. Besides, anatomical peculiarities of veins, which prevent or make it difficult to pass a radiofrequency catheter, may induce the doctor to refuse to perform this procedure.
Does radiofrequency ablation require any special preparation?
Radiofrequency ablation doesn’t require any special preparation: there is no any need to perform intervention on an empty stomach (a light breakfast is to the good), it is not necessary to shave the area of interference (if the procedure doesn’t involve micropunctures).