Definition and Overview
Endovenous radiofrequency therapy is a minimally invasive procedure used as a treatment for varicose veins, venous reflux, venous insufficiency, and other types of medical problems affecting the veins. The procedure can help relieve the debilitating symptoms of such conditions, such as pain and bleeding. Compared to other alternative treatment methods, venous ablation procedures also speed up patients’ healing and recovery. Thus, it is now the treatment of choice for many individuals suffering from venous conditions.
Who Should Undergo and Expected Results
Endovenous radiofrequency therapy is an ideal treatment for patients suffering from the following conditions:
Varicose veins – This is a common venous condition that affects around 26% of the adult population. Varicose veins are large and raised blood vessels that are easily visible through the skin. They are sometimes painless and are often categorised as a cosmetic issue, but they can also be painful and debilitating.
Spider veins – Spider veins are smaller than varicose veins. They look like small red or purplish blue blood vessels that have a twisted appearance.
Chronic venous disorders (CVDs) – These disorders usually affect the lower extremities and are associated with venous hypertension.
Venous conditions typically affect patients who meet the following risk factors:
Female gender – Females are more likely to develop varicose veins than males, possibly due to female sex hormones that cause veins to dilate more easily. Their symptoms also tend to increase when they’re having their menstrual period.
Genetic disorder – Some people are genetically predisposed to venous conditions due to their abnormally weak venous walls.
Pregnancy – Pregnant women are likely to develop varicose veins even if they have no history of venous conditions in the past. This is believed to be due to the increase in a woman’s total blood volume that occurs during [pregnancy](http://www.docdoc.com/info/procedure/pregnancy.
Obesity – Heavier weight can put more pressure on the veins.
Occupation – Some people are more prone to developing varicose veins as a result of their jobs or normal activities. For example, people who sit for extended periods of time are more at risk than people who move around a lot.
Varicose veins, spider veins, and other venous problems can significantly affect patients’ quality of life, as they are frequently accompanied by discomfort, pain, loss of mobility resulting in loss of productivity, and overall deterioration. In the past, these conditions warranted an open surgical procedure for treatment. More recently, however, minimally invasive procedures have become the norm.
While there are many alternative treatment options for venous conditions, endovenous ablation bears many advantages over them. Over the years, doctors have prescribed treatments such as:
Venous ligation and stripping or phlebectomy – This is a traditional surgical approach to treating varicose veins. Ligation refers to the typing off of large veins, while stripping pertains to how the vein is removed. This is usually done behind the knee or in the groin area.
Foam sclerotherapy – This is a procedure where a chemical called a sclerosant is injected into spider veins causing them to collapse. In the past, a liquid sclerosant was traditionally used, but they were only effective on smaller veins. Foam sclerotherapy, however, is effective for medium to large veins due to the thicker consistency of the foam sclerosant used during the procedure.
Endovenous laser therapy
Endovenous radiofrequency therapy is the newest and most advanced among these treatment options. Along with its laser-based counterpart, both endovenous techniques are known for their minimal risk of post-operative complications. They are thus considered as the safest yet effective treatment for venous conditions.
However, endovenous vein ablation therapy does have its limitations. While it is effective in most cases, it is not the most cost-effective option for very small or very large veins, particularly due to the cost of the catheters used during the procedure. Thus, there is a minimum vein diameter limit of 0.4 cm and a maximum vein diameter limit of 1.8 cm for the procedure.
Nevertheless, given proper patient selection and arterial sufficiency, patients can expect the following significant improvements in their condition following the procedure:
No unsightly scars
No more unsightly veins that can be seen through the skin
Prevention of skin problems, such as eczema, skin ulcers, and abnormal pigmentation, that may occur due to varicose veins
Thanks to the minimally invasive nature of the procedure, it also reduces patients’ recovery times. Patients generally take just two days off from work following the procedure, and most of them do not require pain relievers. Those who needed pain relievers mostly used ibuprofen or acetaminophen. Due to its many benefits, the procedure has high patient satisfaction ratings, with 99% of them showing successful vein occlusion during an ultrasound scan conducted two weeks following the procedure.
How is the Procedure Performed?
An endovenous radiofrequency therapy is an outpatient procedure that can be performed under local anesthesia and without a hospital stay. In the past, however, patients undergoing open surgery for venous conditions require general anesthesia and need to stay in the hospital for an extended time.
Prior to the procedure itself, the patient’s affected leg is prepped. An antiseptic solution is applied to ensure the area is sterile during the procedure. The affected vein is then cannulated and a local anesthetic is injected around it. An ultrasound is then used to provide visual guidance during the procedure.
During an endovenous radiofrequency therapy, a catheter electrode is used to deliver alternating radiofrequency currents to the affected veins. The catheter only requires a very small incision for it to be inserted into the target vein, so a large surgical cut is no longer necessary. As the radiofrequency energy enters the damaged veins, the veins contract and collapse until it seals completely, after which it is naturally absorbed into the bloodstream. Blood is then re-routed to nearby healthy veins. The whole procedure generally takes around 45 minutes to 1 hour. The expected results can be visible within 1 to 2 weeks, after which the patient is asked to return to the doctor for a follow-up check to assess the results of the procedure.
Possible Risks and Complications
Patients who undergo endovenous radiofrequency therapy face a low, controlled risk of the following potential complications:
Saphenous nerve injury
Residual large veins
Patients are advised to wear compression stockings for up to 2 weeks to keep the swelling and bruising minimal. They are also given instructions that will facilitate faster healing and allow them to return to their regular activities at the soonest possible time.
Kayssi A, Pope M, Vucemillo I, Werneck C. “Endovenous radiofrequency ablation for the treatment of varicose veins.” Can J Surg. 2015 Apr; 58(2): 85-86. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4373988/
Dietzek CL. “Endovenous radiofrequency ablation.” Vein and Vascular Institute. http://www.veinvascular.com/vein-problems-treatments/vein-treatments/endovenous/
Weiss M. 2016 Feb 15. “Radiofrequency ablation therapy for varicose veins.” Medscape. http://emedicine.medscape.com/article/1085800-overview