Radiofrequency Ablation In Terms Research Articles

Current clinical evidence on endovenous laser ablation (EVLA) from randomised trials

SummaryBackground Endovenous laser ablation (EVLA) is globally counted among the most frequently administered methods to treat saphenous vein incompetence. Technical development proceeded in three particular steps: EVLA #1 – Diode lasers linearly emitting wavelengths from 810 to 980 nm through optical bare fibres; EVLA #2 – Diode or Nd:YAG lasers emitting wavelengths from 1064 to 1500 nm; EVLA #3 – Modified optical fibres warranting an optimised emission geometry by centralisation of the fibre tip (Tulip-fibre, Jacket-tip) or radial emission of the laser beam. Due to the number of different EVLA techniques their value compared with standard surgery (high ligation and stripping, HLS) and other endovascular approaches has to be questioned.Methods Selective literature analysis based on a systematic PubMed search focussed on randomised controlled trials (RCT) comparing EVLA with HLS and other thermal or nonthermal ablation techniques – radiofrequency ablation (RFA), ultrasound guided foam sclerotherapy (UGFS), endothermal steam ablation (EStA).Results The search terms “endovenous”, “laser”, “varicose vein” resulted in 509 publications, hereof 57 RCTs, hereof 24 randomised studies comparing EVLA with other treatment approaches: 15 studies comprise comparisons with standard surgery and further 9 studies with other endovenous techniques. 6 RCTs contain long-term followup data on EVLA #1 vs. HLS suggesting superiority of HLS in terms of same site clinical and duplex detected recurrence from the groin. 15 RCTs are reporting short-term results clearly demonstrating inferiority of EVLA #1 against EVLA #2, EVLA #3, and RFA with respect to postoperative complaints and patients’ quality of life.Conclusions The first generation endovenous laser systems are disadvantageous or even harmful as compared with more advanced EVLA techniques and RFA in terms of patients’ complaints and side effects. Furthermore, evidence is rising that EVLA #1 is inferior to standard surgery regarding long-term treatment efficacy. Therefore, the application of EVLA #1 in the treatment of saphenous vein incompetence cannot be recommended any longer. In view of the more recently published RCTs reporting long-term superiority of standard surgery, HLS should still be implemented as control group in studies investigating endovenous treatment approaches.

Ultrasound-guided Ablative Therapy for Hepatic Malignancies: a Comparison of the Therapeutic Effects of Microwave and Radiofrequency Ablation

Background: Radiofrequency ablation (RFA) is currently the most widely used thermal ablative technique for unresectable hepatic malignancies. However, microwave ablation (MWA) is also gaining popularity worldwide. With a cooled-tip electrode, MWA produces necrotic effects comparable to RFA without damaging soft tissues along the electrode track. In this study, the authors compared the efficacy of these two ablative modalities in the treatment of primary or secondary liver cancer.Materials and methods: Ultrasound-guided MWA was employed to treat 230 cases of liver cancer with a total of 349 nodules and a diameter of 0.8-11.4 cm [mean: 5.7 ± 2.1 cm]. Meanwhile, ultrasound-guided RFA was performed in 92 cases of liver cancer with 173 nodules in total and a diameter of 2.0-10.2 cm [mean: 5.4 ± 1.9 cm]. The clinical data were retrospectively analyzed to identify the differences between MWA and RFA in terms of their operative safety, local ablative effect, cost efficiency, and cumulative survival rate.Results: The patient parameters were comparable. The area of coagulative necrosis was similar in both groups. The tumor complete ablation rate was 83.7% (292/349) for the MWA group and 86.7% (150/173) for the RFA group, which showed no significant difference (P = 0.75). The one-year and two-year cumulative survival rate were all comparable between the two groups (P = 0.66, P = 0.41), which were 90.0% (198/220), 81.6% (120/147) for the MWA group, and 91.8% (78/85), 81.0% (34/42) for the RFA group, respectively. Moreover, both the tumor type and number had no influence on survival rate for the two methods. In addition, there was no significant difference in complication rates between the two groups. The cost for performing one MWA procedure was about 40% lower than that of RFA ($1200 vs $2000). Conclusions: Both MWA and RFA are safe and effective ablative treatments for liver cancer. Additionally, MWA has the advantage of cost efficiency.

Quality of life improvement after radiofrequency catheter ablation of outfl ow tract ventricular arrhythmias in patients with structurally normal hearts

Introduction Patients with structurally normal hearts (SNH) suff ering from ventricular tachycardia (VT) or frequent premature ventricular contractions (PVCs) are at low risk of sudden cardiac death. Any treatment ameliorates symptoms without a substantial infl uence on survival. The aim of this study was to prospectively evaluate the health-related quality of life (QoL) of patients with SNH undergoing elective radiofrequency ablation (RFA) of VT or PVCs.Material and methods Patients scheduled for RFA of VT or PVCs in SNH were enrolled. They underwent 24-h Holter ECG and QoL assessment (SF-36 questionnaire) at baseline and at 3-month follow-up. Results were compared within and between VT and PVCs groups.Results Among 44 enrolled patients: (i) 23 had VT; (ii) 21 had PVCs with a mean count of 18,711 ± 10,378 beats/24h. Antiarrhythmic drugs (sotalol, propafenone) were more frequently used in the VT group than in the PVC group. All patients underwent successful RFA with no major complications with 2 cases of early reablation. At follow-up, a signifi cant improvement 6 of 8 domains of SF-36 was observed in the VT and PVCs groups respectively with no signifi cant diff erence in physical and mental component summary score between both groups.Conclusions Favourable outcome of radiofrequency ablation in terms of quality of life and safety supports the idea of aggressive treatment of ventricular arrhythmia in patients with structurally normal hearts who are symptomatic and/or prone to cardiomyopathy. Comparable improvement of QoL in patients with PVCs and VT is an additional argument for performing ablation in symptomatic patients with frequent ventricular contractions.

Percutaneous Computed Tomography–Guided Radiofrequency Ablation of Lung Tumors Complicated With Idiopathic Interstitial Pneumonia

We report 3 patients with lung cancer complicated with interstitial pneumonia who were treated by percutaneous computed tomography-guided radiofrequency ablation. Patient 1 recovered from a pneumothorax without chest drainage. Patient 2 presented with a progressive pneumothorax after discharge from the hospital and required readmission for air drainage. In patient 3, the pneumothorax did not improve by chest drainage and pleurodesis, and the patient died of acute exacerbation of interstitial pneumonia. Radiofrequency ablation of intractable lung cancer with complicating interstitial pneumonia requires careful consideration because a progressive pneumothorax may require surgical intervention or result in acute exacerbation of interstitial pneumonia.

Percutaneous radiofrequency ablation of osteoid osteoma.

Osteoid osteoma is a benign bone tumor. Patients usually require surgical treatment for reliable pain relief. Difficulties with intraoperative localization of the tumor and anatomic locations that carry a high morbidity with en bloc resection complicate open surgery. Various methods have been developed to lessen the invasiveness of surgery including computed tomography-guided percutaneous radiofrequency thermal ablation. Eleven patients in three different centers were evaluated and diagnosed with osteoid osteoma based on typical histories, physical examinations, and imaging studies. All patients were treated with computed tomography-guided percutaneous radiofrequency thermal ablation after medical treatment failed. Excellent pain relief was reported in 10 patients. One patient suffered recurrence of a femoral neck lesion despite an initial 7-month period without pain. Patients were given a questionnaire to quantify the effectiveness of percutaneous radiofrequency ablation in terms of pain relief and return to function. The current study shows that percutaneous radiofrequency thermal ablation provides reliable, excellent pain relief and early return to function with minimal morbidity as compared with traditional open techniques. The authors suggest that this technique be used for all patients with extraspinal osteoid osteomas that are not immediately adjacent to neurovascular structures.