Radiofrequency Ablation For Varicose Veins Research Articles

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.

Radiofrequency ablation of varicose veins

SummaryBackground: In the search of alternative techniques to high ligation and stripping (HL/S) in the treatment of varicose veins, catheter-ablation methods have been implemented since 1998. Besides endovenous laser techniques (ELT) radiofrequency ablation (RFA) is a successful device in treating insufficiency of the Great (GSV) and Small saphenous vein (SSV). Methods: This review article sums up publications on Closure Plus™, ClosureFAST™, RFITT® (Celon Method), and EVRF®. It discusses the actually favorized treatment protocols and study results. Results of meta-analysis are presented, too.Results: The Closure Plus™ catheter was the first radiofrequency technique to be licensed in Europe in 1998. Trials and meta-analyzes show occlusion rates of 81–89 % after 5 years. The consecutive technique was the ClosureFAST™ (CLF) catheter that was introduced in 2007 and offered more standardization in treatment. Published data show occlusion rates of 98 % after 5 years and low profile on complications. Also in 2007 a bipolar radiofrequency technique called RFITT was presented. Due to lack of standards in treatment protocol it could not get accepted as well as CLF despite of good treatment results (92–98 % occlusion rates after 12 months) and low complications. A new RFA device called EVRF® shows weak evidence so far.Conclusion: Radiofrequency ablation of varicose veins has become a well-established treatment alternative to HL/S mostly represented by CLF.

Mid-Term Report on the Safety and Effectiveness of Endovenous Radiofrequency Ablation for Varicose Veins.

Objective: Endovenous radiofrequency ablation (RFA), a relatively new technique for treating great saphenous varicose veins, is less invasive compared with stripping surgery. This study examined the mid-term safety and effectiveness of RFA for varicose veins.Materials and Methods: We enrolled 104 patients (147 limbs) who underwent RFA for varicose veins of the lower extremities (females, 67; 64.4%). The mean age was 68.9±9.2 years (39–85 years). In 121 limbs (82.3%), there were great saphenous veins. All patients were observed as outpatients for 12 months after the procedure. RFA was performed using ClosureFast™ catheters with tumescent local anesthesia.Results: There was 99.4% occlusion of the treated veins, and partial recanalization was observed in one limb. Endovenous heat-induced thrombosis (EHIT) was identified in five limbs (3.4%). All EHITs were class 1 according to the Kabnick classification, and they disappeared within 1 month of the intervention without antithrombotic therapy. No other major complications were observed. Mean venous clinical severity scores improved from 5.31 at the baseline to 1.10, 0.39, 0.14, and 0.06 at 1, 3, 6, and 12 months, respectively.Conclusion: RFA is a safe and effective strategy for varicose veins of the lower extremities.

下肢静脈瘤ラジオ波焼灼術後のEndovenous heat induced thrombosisの検討

下肢静脈瘤ラジオ波焼灼術後のEndovenous heat induced thrombosisの検討

Radiofrequency ablation of varicose veins improves venous clinical severity score despite failure of complete closure of the saphenous vein after 1 year

Endovenous treatment is increasingly supplanting open surgery for the treatment of varicose veins. Among emerging endovenous techniques, radiofrequency ablation (RFA) with a ClosureFast catheter is popular in Korea. The objective of this study was to evaluate and compare the efficacy and patient-reported outcomes of RFA of varicose veins. This is a retrospective study of a prospectively registered database of patients who underwent RFA for varicose veins from 2012 to 2013 in St. Mary's Hospital in Seoul. Korea. Efficient ClosureFast RFA catheters (Medtronic, San Jose, CA, USA) were used. The techniques used for RFA of varicose veins were performed according to the manufacturer's recommendations. Duplex scans and venous clinical severity scores (VCSSs) were used to document treatment outcome and patient symptoms before and after the procedures. Treatment outcomes were estimated before the procedure and 3months, 6months, and 12months after the procedure. Outcomes were analyzed by paired t test, chi-square test, or Fisher's exact test as well as by logistical regression. A total of 117 patients were evaluated for 183 consecutive RFA procedures (183 limbs). The initial technical success was 97.3% (178/183). The estimated mean VCSS changed over time from 4.0±1.67 at preprocedure to 0.6±1.05, 0.5±1.02, and 0.6±1.14 at 3months, 6months, and 12months after the procedure, respectively. The improved VCSS was maintained 1year after the procedure (p<0.001). Recanalization of the saphenous vein was detected in 20 limbs at the 1-year follow up. The treatment failure group also exhibited a significant decline in the VCSS between preprocedure and 12months (4.8±1.76 vs. 1.8±2.04, p<0.001). Specifically, in the treatment failure group, 65% of limbs with episodic recanalization (13/20) were reoccluded or recanalized without venous reflux at the 1-year follow up. In this study, RFA of varicose veins had an initial success rate of 97.7% and a significantly improved patient VCSS at 1year. Patients with episodic recanalization of the saphenous vein also exhibited an improved VCSS with favorable duplex findings at 1year.

Our Experience with Radiofrequency Ablation of Varicose Veins of the Lower Extremities

Our Experience with Radiofrequency Ablation of Varicose Veins of the Lower Extremities

Radiofrequency ablation of varicose veins: Best practice techniques and evidence.

This article systematically reviews the practice of radiofrequency ablation of lower limb varicose veins. We present the clinical evidence and best practice techniques for currently available devices. Manufacturer's instructions-for-use were requested for all radiofrequency devices. The MEDLINE and EMBASE databases were searched using the following keywords: 'varicose veins' AND 'radiofrequency' OR 'radio frequency' OR 'Venefit' OR 'ClosureFAST' OR 'RFiTT' OR 'EVRF' OR 'VeinCLEAR', generating 240 articles. Titles and abstracts were screened, yielding 63 articles directly relevant to the scope of the review. Reference lists for publications were also searched to identify further manuscripts of relevance. The Cochrane Database and current National Institute for Clinical and Healthcare Excellence guidelines for varicose veins were also searched from relevant articles. Four radiofrequency ablation (RFA) systems are currently commercially available. Generic practice methods (common to all RF systems) and device-specific techniques are described. The weight of current evidence relates to the use of Covidien Venefit™ (formerly VNUS ClosureFAST™), which clearly demonstrates clinical advantages over open surgery at least to 2 years follow up. However, contemporary studies of the radiofrequency-induced thermal therapy device (RFiTT®), show that in experienced hands, clinical equivalence to the Venefit™ procedure can be achieved. The evidence base for EVRF® and VeinCLEAR™ devices is currently weak and absent, respectively. Despite widespread uptake of RFA and acceptance of its clinical advantages over open surgery there is a paucity of Class 1 A evidence. This results from incongruent reporting of clinical outcome measures within existing literature. Similarly, lack of long-term follow-up studies precludes comparison of the durability of short- and medium-term advantages of RFA with the longer term results of open surgery. There remains scope for a large prospective high-quality trial to assess the clinical, anatomical and cost-effectiveness outcomes for the four commercially available RFA devices, with a particular focus on long-term follow up.

Mathematical modeling of radiofrequency ablation for varicose veins.

We present a three-dimensional mathematical model for the study of radiofrequency ablation (RFA) with blood flow for varicose vein. The model designed to analyze temperature distribution heated by radiofrequency energy and cooled by blood flow includes a cylindrically symmetric blood vessel with a homogeneous vein wall. The simulated blood velocity conditions are U = 0, 1, 2.5, 5, 10, 20, and 40 mm/s. The lower the blood velocity, the higher the temperature in the vein wall and the greater the tissue damage. The region that is influenced by temperature in the case of the stagnant flow occupies approximately 28.5% of the whole geometry, while the region that is influenced by temperature in the case of continuously moving electrode against the flow direction is about 50%. The generated RF energy induces a temperature rise of the blood in the lumen and leads to an occlusion of the blood vessel. The result of the study demonstrated that higher blood velocity led to smaller thermal region and lower ablation efficiency. Since the peak temperature along the venous wall depends on the blood velocity and pullback velocity, the temperature distribution in the model influences ablation efficiency. The vein wall absorbs more energy in the low pullback velocity than in the high one.

The Clinical Outcomes of Endovenous Radiofrequency Ablation of Varicose Veins: Results from the Korean Radiofrequency Ablation Registry

The Clinical Outcomes of Endovenous Radiofrequency Ablation of Varicose Veins: Results from the Korean Radiofrequency Ablation Registry

Local anesthesia with lidocaine and prilocaine, using the tumescent technique, for the radiofrequency ablation of lower extremity varicose veins

To demonstrate the possible use of a tumescent solution containing lidocaine and prilocaine for radiofrequency-assisted segmental thermal ablation and to reduce the need for postoperative analgesics. Fifty patients (51 limbs) underwent radiofrequency-assisted segmental thermal ablation (VNUS Closure FAST(™) ) of insufficient great and small saphenous veins and phlebectomy. The amount of tumescent fluid injected was noted, and evaluation of pain reported on visual analog scale (VAS) and quantity of the postoperative analgesics used and their side effects were recorded one day and sixweeks after the procedure. The average amount of a tumescent fluid injected was 852ml/patient (250-1470ml). One day after surgery, 65% of the patients reported no pain (VAS 0), 27% reported a VAS of 1, and 4% reported a VAS of 2 on a scale of 0-10. Overall, 4% of the total patient population used analgesics after the procedure. Six weeks after the procedure, 84% of the patients reported no pain. Local anesthesia with lidocaine and prilocaine, and the tumescent technique, were found to be effective and safe modalities for radiofrequency ablation of varicose veins of the lower extremities.

Patient-reported quality-of-life after radiofrequency ablation of varicose veins compared to conventional surgery

The aim of this study was to compare patient-reported quality-of-life scores after radiofrequency ablation (RFA) compared to conventional surgery using the Aberdeen Varicose Vein Questionnaire (AVVQ). A postal questionnaire based on the AVVQ was sent out to 105 patients who underwent RFA and 50 patients who underwent surgery for varicose veins in our unit over a 14-month period. Responses were analysed according to sex and compared between the two groups to determine if there is a difference in the patient-reported quality-of-life scores. The mean AVVQ was calculated for both groups. Responses were received from 57 patients who underwent RFA and 27 patients who had surgery. In the domains of itch, discolouration, analgesia use, ankle swelling, cosmetic concern due to their varicose veins and reporting that their varicose veins affect their choice of clothing, there was a statistically significant difference favouring RFA in female patients. Conversely, in men, there was a statistically significant difference in favour of conventional surgery in the domains of pain, itch, analgesia use, cosmetic concern, affecting choice of clothing and affecting daily activities. There was no statistically significant difference in the mean AVVQ scores. This study has shown that for the female patients in our patient population, RFA results in generally better quality-of-life scores than conventional surgery when assessed using the disease-specific AVVQ. In this cohort, there was a statistically significant difference favouring conventional surgery in men. A number of potentially confounding variables have been discussed.

Prospective nonrandomized comparison of quality of life and recurrence between high ligation and stripping and radiofrequency ablation for varicose veins

PurposeVaricose veins are a major problem worldwide and improvement in quality of life (QoL) is the ultimate goal after treatment of this benign disease. However QoL is highly dependent on personal and social factors. This study compares high ligation and stripping (HS) and radiofrequency ablation (RFA) in terms of QoL and recurrence in Korea.MethodsA retrospective analysis of prospectively collected data between August 2006 and October 2008 was performed for patients undergoing HS and RFA at a single institution. QoL was assessed with a questionnaire preoperatively, at 3 months postoperatively and annually thereafter. Recurrence was assessed by Duplex ultrasound annually after surgery.RESULTSA total of 272 patients completed the questionnaire at 3 months. Among these patients, 155 patients returned for their annual follow-up. There were no significant differences between HS and RFA in global QoL scores, although RFA showed less pain. However, paresthesia rates were also higher after RFA. Recurrence rates were similar between the two modalities, although technical failures were more common after RFA.ConclusionOverall QoL and recurrence rates were similar between the two modalities. The benefits of RFA do not seem to be enough to overcome the higher costs of HS in Korea.

Complications of Radiofrequency Ablation of Varicose Veins

Radiofrequency ablation (RFA) has become a valued weapon in the phlebologist's armoury. It offers ease of use and reproducibility with good outcomes. However, as with all interventions, complications arise. In this review we examine the complications inherent with RFA and their relative risk, with their avoidance measures if available. Overall, we find that RFA offers a very safe procedure with rare severe complications.

Pain Following 980-nm Endovenous Laser Ablation and Segmental Radiofrequency Ablation for Varicose Veins: A Prospective Observational Study

The aim of this study was to evaluate postoperative pain following endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) and identify risk factors for increased pain. Patients undergoing either segmental RFA (VNUS Closure Fast, VNUS Medical Technologies, San Jose, California) or EVLA (980 nm) for varicose veins completed a preoperative disease-specific quality-of-life questionnaire (Aberdeen Varicose Vein Questionnaire [AVVQ]) and a diary card recording postoperative pain, return to normal activities, and return to work. Median 3- and 10-day pain scores were calculated. In all, 81 patients returned diary cards (RFA = 45, EVLA = 36). Patients receiving RFA reported less postoperative pain than those receiving EVLA at 3 days (14.5 vs 25.8 mm, P = .053, Mann-Whitney U test) and 10 days (13 vs 23.3 mm, P = .014, Mann-Whitney U test) and returned to work earlier than those receiving EVLA (median 5 vs 9 days, P = .022). Patients treated with segmental RFA had less postoperative pain and returned to work quicker than those treated with EVLA.

VNUS Closure radiofrequency ablation of varicose veins

SummaryEndovenous procedures are increasingly being used to eliminate epifascial variose veins. The radiofrequency therapies VNUS Closure and VNUS Closure FAST Catheter have established themselves and boast very good results compared to other endovenous procedures with regard to closure rates and postoperative quality of life. Equipment and method: Between February 2005 and December 2009, a total of 2413 patients comprising 3366 great and small saphenous veins were operated upon at the Vascular and Venous Diseases Department of DERMATOLOGIKUM HAMBURG. 2241 great and small saphenous veins were treated with the VNUS Closure FAST catheter, 1125 great and small saphenous veins were treated with the Closure PLUS catheter system. Additionally, 264 recurrent varicose veins were treated with the Closure FAST system. Ultrasound examinations were conducted 7 days after the treatment, again 6 weeks after the treatment, and at the follow-up examination one year after treatment. Any recanalisations were treated immediately. Between January 2007 and January 2009, 57 patients were also treated for perforant veins between stages C-4 and C-6. Gender and age distributions, as well as CEAP classifications corresponded to standard distributions. Compression stockings were only administered in the case of advanced chronic venous insufficiency (C-4 to C-6). The patients were anticoagulated before treatment by means of a low molecular weight heparin as a single shot prophylactic. Anticoagulation through thrombocyte aggregation inhibitors or dicumarin was continued. Results: 1089 great and small saphenous veins were examined after removal with Closure PLUS radiofrequency therapy. The primary closure rate after 6 weeks was 98.9%; after one year, 91.2%; after two years 99.0%; after three years, 98.2%; and after four years, 100%. 2241 great and small saphenous veins were treated with the VNUS Closure FAST Radiofrequency System. 2096 great and small saphenous veins were examined after treatment. The primary closure rate after 7 days was 99.7%; after 6 weeks, 99.6%; after one year, 98.8%; and after two years, 100%. The rate of minor complications after Closure FAST Radiofrequency catheter treatment of the great saphenous vein was 5.3%; after treatment of the small saphenous vein, 5.9% in total. No major complications – such as deep vein thromboses or pulmonary embolisms – were caused, and neither was burning of the skin. The closure rate one week after RFS treatment was 84.6%; after 6 weeks, 86.2%; and after one year, 78.3%. In all of the recurring varicose veins, the recirculation was successfully eliminated. Conclusion: The VNUS Closure FAST Radiofrequency catheter represents a standardised, established procedure for treating epifascial varicose veins to ensure the certain elimination of recirculation. The development of Closure PLUS 6-French and 8-French catheter into Closure FAST Radiofrequency catheter has led not only to a reduced operation duration but also a safe and high closure rate after follow-up. With the new concept of segmental ablation the Closure FAST system eliminates the catheter pullback variability and standardises and simplifies the procedure. The success of the treatment is shown by the complete decomposition of the vein underneath the inflow of the superficial epigastric vein or the inflow of the gastrocnemic veins. However, the long term results for the Closure FAST system are awaited eagerly. The current high closure rates and high patient satisfaction rates give us cause to look ahead with hope.

A rare cause of foot drop after radiofrequency ablation for varicose veins: Case report and review of the literature

The treatment option for varicose veins (VV) is mainly surgery both open and minimally invasive. Even though mortality and major morbidity are rare with surgery, minor neurological complications like cutaneous nerve injuries remain a common problem. Involvement of major branches of sciatic nerve is extremely a rare complication of radiofrequency ablation (RFA), the other treatment option for VV. To the best of our knowledge, injury to both peroneal and tibial nerves has not been reported following RFA procedure. We report a very rare complication of sudden onset foot drop after RFA for VV. Lack of knowledge of such symptoms may lead to misdiagnosis and electrodiagnostic and magnetic resonance imaging studies can help in correct diagnosis.