Radiofrequency Ablation For Varicose Veins Research Articles

Radiofrequency ablation of varicose veins in combination with ultrasonic-assisted wound debridement and platelet-rich plasma as well as platelet-rich fibrin technologies in treatment of lower extremity venous ulcers in office-based surgery.

Introductionfor the treatment of varicose ulcer performed clinical and laboratory reasoning of the use of ultrasonic-assisted venous ulcer debridement and Platelet-rich plasma with radiofrequency ablation in an outpatient setting, was carried out.Methodsultrasonic-assisted debridement of trophic ulcer were performed for 50 patients with lower extremity varicose veins at decompensation stage. The effectiveness of ultrasonic-assisted debridement was evaluated by indicators of bacteriological, morphological, cytological study and assessment of trophic ulcers according to the MEASURE system. After ultrasonic-assisted debridement, the patients were divided into two groups: 30 patients, who underwent combined Platelet-rich plasma to stimulate wound regeneration and 20 patients, for whom the Granuflex hydrocolloid bandage was applied for the same purpose.Resultsa comparative analysis of ulcer regeneration in two groups of patients proved that in cases of platelet rich plasma the time of transition from inflammatory-regenerative type to regenerative one is much shorter than when using a hydrocolloid dressing. In 28 patients undergoing Platelet-rich plasma (PRP) and Platelet-rich fibrin (PRF), the radiofrequency ablation of the principal superficial and perforating veins was performed. Another 22 patients performed autodermoplasty of trophic ulcers after radiofrequency ablation.Conclusionour experience has shown that in a one-day inpatient surgical clinic such a multidisciplinary approach to treatment of venous ulcers, including ultrasonic-assisted debridement that is stimulation of wounded process by Platelet-rich plasma with further surgeries to remove the causes of decompensated chronic insufficiency, is promising regarding low costs of treatment and rehabilitation of these patients.

Reducing tumescent anesthetic injection pain by topical anesthesia pretreatment among patients undergoing endovenous radiofrequency ablation of varicose veins: A double-blind randomized controlled trial.

Tumescent anesthesia frequently causes the intraoperative and postoperative pain during radiofrequency ablation (RFA) of varicose veins. We have to find a way to reduce pain caused by these injections. This randomized controlled trial investigated the effectiveness of topical anesthesia pretreatment (TAP) on relieving needle puncture pain during administration of tumescent anesthesia among patients undergoing RFA of varicose veins. Eligible patients treated with RFA were recruited and randomized to either application of TAP with lidocaine-prilocaine cream (EMLA) or water-based cream (placebo). The primary outcome was patient described pain scores on the visual analogue scale (VAS) at different time points during the procedure. Secondary outcomes were technical success rate, complications, satisfaction level, expense, and extra analgesia use. Sixty-two patients were randomized: 32 to EMLA and 30 to placebo. Both groups had comparable baseline demographics, CEAP classification, and Venous Clinical Severity Score (VCSS). Less tumescent anesthetic needle puncture pain was found in the EMLA group (22 ± 7 vs 42 ± 8, p < .01). Pain scores of other time points were equivalent. There was less pain in EMLA pretreated area compared to non-pretreated area in the same patient during needle puncture (22 ± 7 vs 45 ± 7, p < .01), and similar phenomena did not appear in the placebo group. There was no statistical difference in complications, satisfaction level, expense, and technical success between the two groups. And no extra analgesia was used in all patients. We recommend the routine use of TAP to reduce the needle puncture pain during tumescent anesthesia in RFA of lower extremity varicose veins.

Postoperative Outcomes of Cyanoacrylate Embolization Compared to Radiofrequency Ablation for Varicose Veins

Postoperative Outcomes of Cyanoacrylate Embolization Compared to Radiofrequency Ablation for Varicose Veins

Radiofrequency ablation of varicose veins: experience at a tertiary hospital

Background and objectives: Radiofrequency ablation (RFA) is a recent modality of treatment of the affected varicose vein. In the present study, the outcome of great saphenous varicose vein disease treated by radiofrequency ablation technique was analyzed.&#x0D; Methods: Patients with varicosities of the lower limb affecting mainly the great saphenous vein were (GSV) included. The procedures were carried out under spinal anesthesia. The target varicose vein was accessed by Seldinger technique and the RFA catheter advanced 2 to 3 cm below sapheno-femoral junction under ultrasonography (USG) guidance. A tumescent anesthetic infiltration was given in a solution of normal saline and sodium bicarbonate before the vein being ablated.&#x0D; Results: The success rate of RFA was 97.5 % (39 out of 40). One patient showed episodic recanalisation of vein at one year duplex colour scan. Though the complications related to procedure were negligible, one patient developed endovenous heat induced thrombosis (EHIT) and non-fatal pulmonary thromboembolism (PTE) which was managed adequately.&#x0D; Conclusion: Endovenous RFA is a useful treatment modality for varicose vein disease primarily due to great saphenous insufficiency with marked symptomatic improvement and least recurrence. Although the complications are minimal, EHIT is a potential and serious complication of heat ablation.&#x0D; Ibrahim Med. Coll. J. 2021; 15(1): 37-40

Editor's Choice - Role of Compression After Radiofrequency Ablation of Varicose Veins: A Randomised Controlled Trial

This randomized controlled trial of 100 consecutive patients with symptomatic venous insufficiency underwent RFA for mostly C3 to C4 disease. Randomization was done at the end of the procedures, 80% had RFA of saphenous veins, with patients opening a sealed envelope. Patients who wore compression stockings following radiofrequency ablation (RFA) did not have better outcomes than those who did not wear compression. Class 2 (23-32 mm Hg) compression was applied to the compression cohort who wore the hose for 2 weeks. Multiple satisfaction questionnaires were completed by all participants. At 12 weeks, there were no differences in occlusion rates (98% both groups), mean Aberdeen Varicose Vein Severity Scores and Revised Venous Clinical Severity Scores, satisfaction and pain scores, and deep venous thrombosis events. Although this relatively small clinical trial showed that there was no added benefit to compression following RFA for venous insufficiency, it is interesting that compression was only worn for 2 weeks. It is good to know that patients who cannot tolerate compression or in whom lighter compression is used will not have decreased occlusion rates as a result. But we also know that recanalization is not always accompanied by recurrent symptoms. My take home message is not to decline treatment to a patient who cannot tolerate long-term compression.

Radiofrequency ablation of varicose veins, How do I do it?

Radiofrequency ablation of varicose veins, How do I do it?

Interesting Scenarios during Radiofrequency Ablation of Varicose Veins at University Hospital of Nepal.

A varicose vein is a common venous condition which affects the great saphenous vein and small saphenous vein causing symptoms of pain, edema, itchiness, pigmentation, and ulceration. There are various modalities of the treatment of varicose veins; however, radiofrequency ablation is among the tested and proven treatments for varicose veins. With every case, there can be some unexpected or interesting scenarios which can pose both technical and surgical difficulties. The main objective of this paper is to introduce these scenarios which can occur despite following the standard protocol and methods both preoperatively and intraoperatively. In these scenarios, the surgeon quickly need to decide how to deal with the aberrations. Based on extensive literature and consensus of a team of three vascular surgeons, lists of interesting scenarios were prepared along with their definition. Any occurrences of such scenarios were noted in the operation theatre note. Here, we describe 39 (6.38%) interesting cases among 611 cases of radiofrequency ablation that was performed in Dhulikhel Hospital, Kathmandu University Hospital, from January 2014 until December 2019. Despite following the proper protocol, we can face many unexpected challenges preoperatively, peroperatively, and postoperatively. From this article, we concluded that vigilance of all the factors and proper Doppler ultrasonography can help in identifying most of these scenarios and aid in making proper surgical planning.

Endovenous Laser Ablation of Saphenous Veins Larger than 2 cm: a Prospective Study

Background. The current catheters and fibres used for endovenous laser and radiofrequency ablation of varicose veins have a radial energy emission. This gives an opportunity to treat veins of a large diameter which was previously considered to be challenging. The majority of studies categorise veins of more than 1 cm in diameter as large (Chaar C.I., et al. 2011; Florescu C., et al. 2014). Many patients have saphenous veins 1–2 cm in diameter, which can be occluded in almost 100% of cases. Treating veins more than 2 cm in diameter with tumescent anaesthesia may be associated with formation of a “blind pocket”. This means that a part of the vein does not have appropriate contact with the fibre. This can be one of the reasons for recanalisation. The aim of this study was to investigate the results of endovenous laser ablation (EVLA) of saphenous veins larger than 2 cm in diameter. Methods. This was a prospective non-comparative study that included 231 patients who underwent 261 EVLA of the great saphenous vein (GSV) between November 2014 and June 2019. EVLA was performed using 1470 nm laser, radial fibres, and an automatic pull back device. All procedures were performed under tumescent anaesthesia. The average diameter of the veins at the saphenofemoral junction was 24 ± 6 mm (range 21–43 mm). EVLA was administered at the average power of 8–10 W. The linear endovenous energy density in dilated segments was 83–147 J/cm. The follow up period was 178 ± 67 days (range 61–540 days). Duplex ultrasound was performed on days one and seven, and months two and six after the treatment. Results. Two hundred and thirty (88%) veins were occluded the day after EVLA. In 31 (12%) cases there were non-occluded segments of dilated parts of the saphenous vein on the day after the procedure. These segments were found to be occluded in 21 of 31 patients at seven days. In 11 (4%) cases, ultrasound guided foam sclerotherapy (UGFS) was performed. Short stumps of GSV (19 ± 6 mm) were found in 12 (5%) patients at six month follow up, with no reflux in these stumps. Recanalisation of a long segment of the GSV with reflux was found in two (0.8%) cases, which was treated by EVLA and UGFS. Conclusion. EVLA using radial fibres is effective for a GSV more than 2 cm with a 99% occlusion rate in the early follow up period.

The proximity of the superficial epigastric vein to the saphenofemoral junction is associated with endovenous heat-induced thrombosis after radiofrequency ablation for varicose veins

ObjectiveTo elucidate the risk factors of endovenous heat-induced thrombosis (EHIT) after radiofrequency ablation (RFA) for varicose veins in association with the superficial epigastric vein (SEV) position to the saphenofemoral junction (SFJ). MethodsWe examined 125 legs from 218 patients (mean age, 67 years; 80 female legs) with great saphenous veins (GSVs) in association with the SEV proximity to the SFJ using the duplex ultrasound test. According to the Clinical, Etiology, Anatomy and Pathophysiology classification (CEAP; C1-C6), there were 62, 38, and 25 legs in the C2, C3, and C4-C6 categories, respectively. The postoperative duplex ultrasound tests, focused on EHIT, were conducted on days 1, 7, 30, and 90 after RFA. The EHIT analysis was based on Kabnick's classification (class 1-4). We compared the GSV diameter and the SEV-SFJ distance between the EHIT positive (n = 32) and negative groups (n = 93) using the Student t-test. The risk factors (age >75, male sex, ≥C3 classification, adjunctive phlebectomy, prior venous surgery history, GSV diameter of >7.5 mm, and short SEV-SFJ distance [<4 mm]) were examined using univariate and multiple logistic regression analyses. ResultsThe EHIT ratio after RFA was 25.6% (24, five, three, and no legs in classes 1, 2, 3, and 4, respectively). In the EHIT positive group, the mean GSV diameter and the SEV-SFJ distance were larger (8.0 ± 2.3 vs 6.4 ± 2.0 mm; P < .001) and shorter (5.2 ± 4.0 vs 6.8 ± 3.7 mm; P = .05) than the negative group. Using univariate analysis, the risk factors of EHIT after RFA were as follows: ≥C3 classification (odds ratio [OR], 4.15; P = .002), GSV diameter >7.5 mm (OR, 3.50; P = .003), and short SEV-SFJ distance (OR, 2.92; P = .01). Multiple logistic regression analysis showed that a classification of ≥C3 (OR, 3.39; 95% confidence interval [CI], 1.30-8.86; P = .013), GSV of >7.5 mm (OR, 3.32; 95% CI, 1.33-8.25; P = .010), and short SEV-SFJ distance (OR, 2.71; 95% CI, 1.09-6.71; P = .032) were also significant risk factors. ConclusionsRFA treatment for patients with varicose veins should be considered postoperatively in combination with a classification of ≥C3, GSV diameter of >7.5 mm, and a history of deep venous thrombosis and concomitant procedures, because it is related with greater chances of EHIT development.

Role of Compression After Radiofrequency Ablation of Varicose Veins: A Randomised Controlled Trial

Role of Compression After Radiofrequency Ablation of Varicose Veins: A Randomised Controlled Trial

Editor's Choice – Role of Compression After Radiofrequency Ablation of Varicose Veins: A Randomised Controlled Trial☆

Post-procedure limb compression, hitherto routine following open varicose vein surgery, has been extended to endovenous procedures. However, no robust evidence exists to support this practice. Most of the previous studies have focused on the ideal duration of compression. This study evaluates the clinical and patient reported outcomes with and without post-procedure leg compression following radiofrequency ablation (RFA). This single centre, prospective, non-inferiority randomised controlled trial recruited adult patients, into two groups (A: RFA with compression stocking for two weeks, B: RFA alone). The primary outcome was ultrasound determined target vein obliteration at 12 weeks. Secondary outcome measures included a Quality of Life (QoL) score [Aberdeen Varicose Vein Severity Score (AVSS) and Revised Venous Clinical Severity Score (RVCSS)], patient satisfaction, pain score, and complications. In total, 100 consecutive patients were recruited (A: 51; B: 49) classified as clinical class C2-C6 of the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification. At 12 weeks the occlusion rate of the target vein was similar in both groups at 98% (n=47) and 98% (n=45), respectively (p=1.0). There was no statistically significant difference in mean AVSS 6 vs. 5.0 (mean difference-1, 95% CI-2 - 3, p=.57) and mean RVCSS 3 vs. 4 (mean difference 1, 95% CI-1 - 2, p=.46) scores at 12 weeks. Comparable patient satisfaction scores were observed (p=.72) and pain score 2.0 vs. 2.0 (p=.92) were achieved in both groups. Two patients in each group developed deep vein thrombosis at two weeks follow up (p=1.0 for above the knee and p=1.0 for below the knee). The clinical and patient reported outcomes following RFA without compression are no worse than with compression. This trial supports the conclusion that the widely practised use of compression after RFA adds no clinical benefit for the patients. However, a much larger study, preferably a multicentre trial, may be required to confirm this conclusion.

”Geometry-based cannulation technique” for cannulation of great saphenous vein during radiofrequency ablation of varicose veins at a university hospital of Nepal

Background: Radiofrequency ablation is an established minimal invasive treatment modality of varicose veins. This technique involves accessing the great saphenous vein (GSV) through which radiofrequency ablation catheter is inserted. Some established puncture techniques like in-plane and out-plane techniques are also not devoid of limitations. Aims and Objectives: To know the applicability of “Geometry based cannulation technique” in terms of mean cannulation attempts and percentage of successful cannulation. Materials and Methods: We are doing “Geometry based cannulation technique” for the cannulation of GSV. For cannulation 18G needle of length 3 cm attached with 10 ml syringe (cannulating needle) partly filled with normal saline is used. Doppler ultrasonography is done with Siemen's Acuson P300 machine with linear probe of frequency 7.5–12 MHz. The depth from the skin to the upper part of vein is measured in cm and is termed as distance “A.” The tip of the cannulating needle is positioned on the middle of the probe and gently pressed down the skin to form the shadow in the Doppler. The needle is readjusted such that the shadow corresponds to the GSV. Then, the needle is moved distally to A distance. Then the needle is made rotated 45° and skin is punctured to the length (distance B) calculated from the Pythagoras theorem as square root of 2A2. Then the angle is decreased to about 30° and further 2–3 mm advancement of the cannulating needle is done such that it lies inside the target GSV. Results: From 459 cannulations in the time frame of August 2013–December 2018, we found that mean cannulation attempts were 1.4 (standard deviation 0.72, 1–3 attempts). In 429 GSVs (95.5%), there were successful cannulations, whereas in 20 GSVs (4.5%), there was failure in cannulation. The cannulation of GSV has higher success if the diameter of GSV is more than 5 mm and the depth is less than 10mm. Conclusion: “Geometry based cannulation technique” for cannulation of GSV is a novel technique and can be used with high success.

Safety and Efficacy of Radiofrequency Ablation for Varicose Veins: An Initial Experience from Pakistan.

To evaluate the safety and efficacy of radiofrequency ablation (RFA) for varicose veins. Observational case series. Section of Vascular Surgery, Aga Khan University Hospital, Karachi, from September 2016 to August 2018. Data of RFA procedures performed on 40 patients were collected on a questionnaire from the medical records. It included patients' demographics, pre- and postoperative clinical, etiological, anatomical and pathological (CEAP) system score, venous clinical severity score (VCSS), procedural details and intra- or postoperative complications. Outcome measures were 'safety of the procedure, which was measured by presence of any complications; and 'efficacy of the procedure' which was measured by improvements in the CEAP and VCSS score. The mean age of the patients was 44.7±11.5 years. Twenty-one (52.5%) patients were women. Preoperative median VCSS [range] was 7 [2-15], which improved to 1 [0-3] (p <0.001). Preoperative median CEAP [range] was 3 [2-6] and improved to 1 [0-4] (p <0.001). One patient had recurrence and five patients (12.5%) had minor complications, which were treated conservatively. RFA in patients with symptomatic varicose veins can be performed with minimal complications. This modality is also effective in reducing the disease severity.

IF15. The Proximity of Superficial Epigastric Vein to Saphenofemoral Junction Is Associated With Endovenous Heat-Induced Thrombosis After Radiofrequency Ablation for Varicose Veins

IF15. The Proximity of Superficial Epigastric Vein to Saphenofemoral Junction Is Associated With Endovenous Heat-Induced Thrombosis After Radiofrequency Ablation for Varicose Veins

Compression Therapy Using Compression Pads Could Avoid EHIT and Stab Avulsion after Radio-frequency Ablation for Varicose Veins

Compression Therapy Using Compression Pads Could Avoid EHIT and Stab Avulsion after Radio-frequency Ablation for Varicose Veins

Efficacy and safety of radiofrequency ablation for lower limb varicose veins

Background: Endovenous Radiofrequency Ablation (RFA) is gradually gaining widespread acceptance as a minimally invasive modality for treatment of varicose veins (VV). The objective of this study was to evaluate the efficacy based on Venous Doppler and Venous Clinical Severity Score (VCSS) and the safety of radiofrequency ablation for varicose veins.Methods: This is a prospective study of 58 consecutive patients who underwent Radiofrequency ablation of Varicose veins from January 2015 to January 2017 in a single unit of a Multispecialty Tertiary Care Hospital. The mean age was 44.10±13.74 years (19-75 years). A total of 78 limbs were treated in 58 patients. RFA was performed using Closure FastTM catheter according to the manufacturer’s recommendation. Treatment outcomes were estimated 15 days, 3 months, 6 months and 1 year after the procedure using Doppler scan and VCSS score.Results: There was 100% occlusion of the treated veins with no evidence of partial/complete recanalization. However, 2 (2.56%) patients had a GSV stump length &gt; 3cm on Doppler at 6 months, without evidence of significant reflux. Minor complications such as ecchymosis erythema, pain and induration rapidly improved over short term. One patient (1.3%) had evidence of Deep Vein thrombosis (DVT) on follow up Venous Doppler. The mean VCSS improved from mean of 7.98 preoperatively to 2.24 after 1 year (P value &lt;0.001).Conclusions: Radiofrequency ablation is a safe and effective procedure with minimal major complications. The minor complications were early and resolved rapidly.

Spinal anesthesia versus general anesthesia with a laryngeal mask airway in patients undergoing radiofrequency ablation for varicose veins

Spinal anesthesia versus general anesthesia with a laryngeal mask airway in patients undergoing radiofrequency ablation for varicose veins

Delayed Recovery of Motor Block Following Radiofrequency Ablation of Varicose Veins with Femoral Nerve Block and Tumescent Anesthesia

Femoral nerve block with tumescent anesthesia is used to perform the radiofrequency ablation of varicose veins. The surgery can be done as day-case. But if recovery from motor block is delayed, it can make hospital discharge difficult. Prolonged femoral nerve blocks with motor blockade of the quadriceps have been noted after the use of bupivacaine. The motor blockade lasted up to 30–40 hours when 15–30 mL of 0.5% bupivacaine was used. However, it was rarely reported in ropivacaine. We report that femoral nerve block with 15 mL of 0.375% ropivacaine induced prolonged motor blockade up to 30 hours.

FT22. Endovenous Heat-Induced Thrombosis After Radiofrequency Ablation for Varicose Veins—When and Why It Happened?

FT22. Endovenous Heat-Induced Thrombosis After Radiofrequency Ablation for Varicose Veins—When and Why It Happened?

Short Term Fate of Great Saphenous Vein after Radiofrequency Ablation for Varicose Veins.

Background Radiofrequency ablation of varicose vein have gained popularity compared to conventional surgery due to comparable long term results in addition to definite immediate superiorities. This modality has been started in Nepal since August 2003 and the study on short term fate of ablated vein segment confirms the anatomical benefit in addition to the clinical benefit. Objective To analyze short term fate of segment of great saphenous vein that has been treated by Radiofrequency ablation in terms of occlusion of saphenofemoral junction and absence of recanalisation on Doppler ultrasonography finding done at 3-6 months postoperative period. Method Total 81 cases subjected for radiofrequency ablation of great saphenous vein in thigh segment during August 2013 - September 2014 were followed up in between 3 to 6 months by Doppler ultrasonography. The findings were classified into type 1 to 4 results based on the anatomic closure of saphenofemoral junction and absence of recanalisation on treated segments. Result There were total 81 cases with 54.3% female and 45.7% male patients. Mean short term follow up duration was 4.9 months (S.D. 1.1 months). Great Saphenous Vein was cannulated most frequently in between 5 cm above knee to 5 cm below knee. Mean number of Radio Frequency Ablation (RFA) segments were 6.6 (SD=3.1). There was complete occlusion (Type 1 results) in 51 cases (63.0%). In 24 cases (29.6%) there was competent saphenofemoral junction with partial recanalisation in distal part of Great Saphenous Vein (GSV) (Type 2 results). In six cases (7.4%) there was incompetent saphenofemoral junction with partial recanalisation in distal part of Great Saphenous Vein (Type 3 results). There were no cases with incompetent saphenofemoral junction with complete recanalisation in distal part of Great Saphenous Vein (Type 4 results). Conclusion Radio Frequency Ablation for varicose vein, besides making clinical improvements, is also associated with good anatomical results.