Radiofrequency Ablation in Vein Disease

In clinical trials, radiofrequency ablation for vein disease has proven to be safe and effective for truncal veins. More importantly, they have proven to be associated with better long-term results, faster recovery and improved quality of life in comparison to older, dated methods like surgical stripping. The modern-day minimally invasive techniques for vein treatment have been revolutionary.

Equipment

The most commonly used device used by a vein doctor is the RF ClosureFASTTM by Medtronic. The ClosureFAST system is based on radiofrequency, thermal-induced destruction of vein walls similar to the concept of laser treatment for spider veins.

Procedure

Radiofrequency ablation is minimally-invasive and can be performed directly in the office. Most vein specialists in NJ perform the procedure in a dedicated room that provides a sterile environment and houses the necessary equipment. In general, thermal ablation is utilized for truncal veins like the GSV and SSV or some of the tributaries.

Access for the ablation catheter is obtained by venipuncture under ultrasound guidance. Prior to access, the area of treatment should be sterilely prepped and draped per usual protocols. Lidocaine or similar local anesthetic is used to numb the region of interest. Using the modified Seldinger technique, the vein is prepared for treatment with the exchange of wires for a percutaneous sheath. In the case of the GSV, access can be obtained anywhere distal to the SFJ (or in the case of the SSV, distal to the SPJ) that provides adequate treatment of the culprit's vein.

The ablation catheter is then advanced into its target position under careful ultrasound guidance making sure that any positioning into deep venous structures is avoided. Before the heat sources are turned ON, the saphenous sheath in the region of interest is infused with diluted tumescence anesthetic (combinations of lidocaine, saline, bicarbonate, and epinephrine).

Epinephrine is used sometimes opted for by the vein specialist in the solution to minimize the vein size when treatment is performed. Tumescence has three purposes: 1) anesthetic 2) collapse the targeted vein to the size of the catheter where treatment can be more effective against the venous walls, and 3) direct collateral tissue and nerves away from the targeted region to reduce risks of injury.

Once adequately anesthetized, the vein doctor NJ will activate the RF generator and heat the tip of the catheter. The catheter will then be withdrawn 6.5cm with each treated segment until the catheter has fully treated the targeted segment and can be withdrawn in entirety from its insertion site. The sheath is also withdrawn and hemostasis at the access site is achieved by manual pressure. Post-procedure aftercare instructions are then provided to the patient by the vein treatment clinic per usual protocol.

At a minimum, the patient will return to their vein specialist within 1 week to rule out any unintended complications, like DVT. Thereafter, each vein clinic follows its own protocol to assess the need for additional treatments based on any continued symptoms. Overall success rates for radiofrequency ablation is >90% in long-term follow-up with fearsome complications like DVT or allergic reactions in proper vein specialists NJ hands less than 1%.