Abstract
Introduction
Endogenous radiofrequency ablation (RFA) is a proven treatment for varicose veins that has equal efficacy to surgical stripping. It offers the benefit of reduced post operative pain and wound infection and quicker return to work.
Aim
To carry out a clinical audit of patients undergoing RFA to monitor outcomes, complication rates, follow-up sclerotherapy and to assess the need for post-operative duplex scan.
Methods
A retrospective analysis was performed of 174 procedures carried out from January 2011 to March 2012. Patients were pre-assessed with history, physical exam and duplex ultrasound. They were followed up at 3 months with same. CEAP classification was applied to check for post-operative improvement.
Results
174 procedures, including 165 great saphenous vein and 9 short saphenous vein ablations were carried out on 154 patients. The duplex occlusion rate at 3 months was 99 %. 141 patients (81 %) showed a reduction in CEAP score with average CEAP decreasing from 2.37 to 0.96. Overall the complication rate was low at 7 %. Paraesthesia was the most common complication with 7 cases (4 %). There were no DVTs. 45.4 % of patients went on to have follow-up sclerotherapy for venous flares.
Conclusion
RFA is a safe and effective treatment for varicose veins. There is no benefit in performing routine short term follow-up duplex scan due to the high occlusion rates.
Similar content being viewed by others
References
Roth SM (2007) Endovenous radiofrequencey ablation of superficial and perforator veins. Surg Clin North Am 87:1267–1284
Golan JF, Glenn DM (2008) Laser and radiofrequency endovenous ablation of venous reflux. Perspect Vasc Surg Endovasc Ther 20(1):75–79
Rasmussen LH, Lawaetz M, Bjoern L, Vennits B, Blemings A, Eklof B (2011) Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg 98:1079–1087
Shepherd AC, Gohel MS, Brown LC, Metcalfe MJ, Hamish M, Davies AH (2010) Randomized clinical trial of VNUS ClosureFAST radiofrequency ablation versus laser for varicose veins. Br J Surg 97:810–818
Carradice D, Mekako AI, Mazari FAK, Samuel N, Hatfield J, Chetter IC (2011) Randomized clinical trial of endovenous laser ablation compared with conventional surgery for great saphenous varicose veins. Br J Surg 98:501–510
Nesbitt C, Eifell R, Coyne P, Badri H, Bhattacharya V, Stansby G (2011) Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices. Cochrane Database Syst Rev (Online) 10:1–66
Merchant RF, DePalma RG, Kabnick LS (2001) Endovascular obliteration of saphenous reflux: a multicenter study. J Vasc Surg 35:1190–1196
Caggiati A et al (2005) Nomenclature of the veins of the lower limb: extensions, refinements, and clinical application. J Vasc Surg 41(4):719–724
Proebstle TM, Alm J, Göckeritz O, Wenzel C, Noppeney T, Lebard C, Pichot O, Sessa C, Creton D, European Closure Fast Clinical Study Group (2011) Three-year European follow-up of endovenous radiofrequency-powered segmental thermal ablation of the great saphenous vein with or without treatment of calf varicosities. J Vasc Surg 54:146–152
Nicolini P; Closure Group (2005) Treatment of primary varicose veins by endovenous obliteration with the VNUS closure system: results of a prospective multicentre study. Eur J Vasc Endovasc Surg 29:433–439
Dunn CW, Kabnick LS, Merchant RF, Owens R, Weiss RA (2006) Endovascular radiofrequency obliteration using 90 degrees C for treatment of great saphenous vein. Ann Vasc Surg 20:625–629
Vasquez MA, Wang J, Mahathanaruk M, Buczkowski G, Sprehe E, Dosluoglu HH (2007) The utility of the venous clinical severity score in 682 limbs treated by radiofrequency saphenous vein ablation. J Vasc Surg 45:1008–1015
Zuniga JM, Hingorani A, Ascher E, Shiferson A, Jung D, Jimenez R et al (2012) Short-term outcome analysis of radiofrequency ablation using ClosurePlus vs ClosureFast catheters in the treatment of incompetent great saphenous vein. J Vasc Surg 55:1048–1051
Bisang U, Meier TO, Enzler M, Thalhammer C, Husmann M, Amann-Vesti BR (2012) Results of endovenous ClosureFast treatment for varicose veins in an outpatient setting. Phlebology 27:118–123
Choi JH, Park HC, Joh JH (2013) The occlusion rate and patterns of saphenous vein after radiofrequency ablation. J Korean Surg Soc 84:107–113
Creton D, Pichot O, Sessa C, Proebstle TM, ClosureFast Europe Group (2010) Radiofrequency-powered segmental thermal obliteration carried out with the ClosureFast procedure: results at 1 year. Ann Vasc Surg 24:360–366
Braithwaite B, Hnatek L, Zierau U, Camci M, Akkersdijk G, Nio D, Sarlija M, Ajduk M, Santoro P, Roche E (2013) Radiofrequency-induced thermal therapy: results of a European multicentre study of resistive ablation of incompetent truncal varicose veins. Phlebology 28:38–46
Malgor RD, Labropoulos N (2012) Diagnosis and follow-up of varicose veins with duplex ultrasound: how and why? Phlebology 27(Suppl 1):10–15
Hingorani AP, Ascher E, Markevich N, Schutzer RW, Kallakuri S, Hou A, Nahata S, Yorkovich W, Jacob T (2004) Deep venous thrombosis after radiofrequency ablation of greater saphenous vein: a word of caution. J Vasc Surg 40:500–504
Subramonia S, Lees T (2010) Randomized clinical trial of radiofrequency ablation or conventional high ligation and stripping for great saphenous varicose veins. Br J Surg 97:328–336
Pan Y, Zhao J, Mei J, Shao M, Zhang J (2014) Comparison of endovenous laser ablation and high ligation and stripping for varicose vein treatment: a meta-analysis. Phlebology 29(2):109–119
Mozes G, Kalra M, Carmo M, Swenson L, Gloviczki P (2005) Extension of saphenous thrombus into the femoral vein: a potential complication of new endovenous ablation techniques. J Vasc Surg 41:130–135
Haqqani OP, Vasiliu C, O’Donnell TF, Iafrati MD (2011) Great saphenous vein patency and endovenous heat-induced thrombosis after endovenous thermal ablation with modified catheter tip positioning. J Vasc Surg 54:10S–17S
Proebstle TM, Vago B, Alm J, Gockeritz O, Lebard C, Pichot O (2008) Treatment of the incompetent great saphenous vein by endovenous radiofrequency powered segmental thermal ablation: first clinical experience. J Vasc Surg 47:151–156
Marsh P, Price BA, Holdstock JM, Harrison C, Whiteley MS (2010) Deep vein thrombosis (DVT) after venous thermoablation techniques: rates of endovenous heat-induced thrombosis (EHIT) and classical DVT after radiofrequency and endovenous laser ablation in a single centre. Eur J Vasc Endovasc Surg 40:521–527
Goldman MP, Weiss R, Gradman W (2005) Deep vein thrombosis after radiofrequency ablation of greater saphenous vein: a word of caution. J Vasc Surg 41:737
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Broe, M., Shaikh, F.M. & Leahy, A. Endovenous radiofrequency ablation: no value in short-term duplex ultrasound follow-up. Ir J Med Sci 184, 641–645 (2015). https://doi.org/10.1007/s11845-014-1194-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11845-014-1194-0