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Varicose vein ablation with RFA-unilateral

  • Posted on- Jan 06, 2018
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Varicose veins are those veins which have become enlarged and twisted. The term commonly refers to the veins on the leg, although varicose veins can occur elsewhere. Veins have pairs of leaflet valves to prevent blood from flowing backward (retrograde flow or venous reflux). Leg muscles pump the veins which help in returning blood to the heart (the skeletal-muscle pump), against the effects of gravity.

Radiofrequency Ablation (RFA) of varicose veins was the first of the new varicose veins treatments to come out. These new treatments are called “endovenous” treatments of varicose veins – or “minimally invasive” surgery or “Keyhole” surgery.

Before endovenous surgery became available, the main way to have varicose veins treated was by stripping.
Radiofrequency ablation of varicose veins uses heat to kill the vein and close it from the inside. It is also known as “endovenous thermoablation” – literally ablating the vein with heat from a device passed up inside the vein.

Radiofrequency ablation of varicose veins uses heat to kill the vein and close it from the inside. And it is also known as ‘’endovenous– which means heating up the vein with the help of device passed up inside the vein.


What is the procedure of varicose vein ablation with RFA- unilateral?




The leg is prepared and draped, and a superficial local anesthetic agent is used to anesthetize the site of cannulation. Duplex ultrasonography bisects the needle puncture of the vessel. The Seldinger technique is used to place a guide wire into the vessel, and an introducer sheath (cover) is passed over the guide wire, that is removed. The Closure Fast catheter is passed through the sheath, and the tip is advanced to 2 cm below the saphenofemoral junction under duplex ultrasonographic visualization.

In the previous system, after the temperature reaches 85°C and remains constant for 15 seconds, the catheter tip is slowly taken back at a rate of approximately 1 cm per minute (1 mm every 6 seconds). The latest system takes two-cycles of 20 seconds in the proximal section, after which the catheter is withdrawn 7 cm as per catheter markings. The next 20-second cycle is repeated once, and, if the temperature of 120ºC is maintained, the catheter is then withdrawn another 7 cm until the entire vein is treated.

A patient should never experience heat during the anesthesia inserted. If this happens, more anesthesia is injected.


What is the pre-procedure of varicose vein ablation with RFA?



Duplex ultrasonography is performed for the confirmation and tracing the refluxing path from the saphenous trunk from the saphenofemoral junction to leg to the lower thigh or upper part of the leg. The vein, the saphenofemoral junction, and the anticipated entry point are marked in some way on the skin. The main point is selected upper or lower part of the knee, at a point for the incision in the vessel with a 16-gauge needle introducer.

What are the types of equipment used in varicose vein ablation with RFA?



•    Radiofrequency generator (VNUS RFG Plus).
•    VNUS Closure FAST segmental ablation catheter. 7F, 60cm. (This is different from continuous pull back type, which was used previously, with advantages of greater consistency and increased speed of ablation).


How is follow-up care of varicose vein ablation RFA?



Compression is of vital importance after any venous procedure. Bulging down results in lowering postoperative bruising and affection, and also lowers the risk of venous thromboembolism in both the treated leg and the untreated leg.

The patient is reevaluated 3-7 days after the operation, at which time duplex ultrasonography should demonstrate a closed greater saphenous vein and no evidence of thrombus (blood clot) in the femoral, popliteal, or deep veins of the calf.

During the 6th week, a test will be done at the clinical resolution of truncal varices, an ultrasonographic evaluation that recognizes a full closed vessel, without any reflux. If any residual open segments are noted, sclerotherapy is performed under ultrasonographic guidance.


What are the complications of varicose vein ablation RFA?



Reported complications of the procedure are rare. Parochial paresthesias roots up from peroneal nerve injury, they are temporary. Thermal injury to the skin was reported in clinical trials when the volume of local anesthetic was not sufficient to provide a buffer between the skin and a particularly superficial vessel, especially below the knee.

Profiting from thrombus with a local superficial phlebitis has observed rarely without the use of compression. The greatest current area of concern is deep vein thrombosis, with a 2004 study documenting deep vein thrombus requiring anticoagulation in 16% of 73 limbs treated with a radiofrequency ablation procedure.

What are the outcomes of varicose thermal ablation?



Favoured results make a higher success rate with a low recurrence rate up to 10 years after the medication. Early and mid-range results are comparable to those obtained with other endovenous ablation techniques. With an experience of 90% success rate, with rare patients requiring a repeat procedure in 6-12 months. Overall efficacy(desired result) and lower morbidity have resulted in endovenous ablation techniques replacing surgical stripping.

High satisfaction, with 95% of patients reporting they would recommend the procedure to a friend.


The minimum cost of varicose vein thermal ablation with RFA is Rs. 1,25,000 to maximum Rs. 3,50,000.

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