Conventional surgery versus endovenous radiofrequency ablation in management of patients with primary varicose veins

Abstract

Conventional surgery has been used for a long time for treatment of varicose veins with variable degrees of minor to major complications. Endovenous RA of VV has been established as a practical and effective alternative to conventional surgery. Segmental radiofrequency ablation provides high ablation rates in conjunction with a very moderate side effect profile. The advantages of RFA are far greater than its associated risks. There are certain points, which need to be carefully addressed during the RFA technique which was taken into consideration during gaining more experience with more number of cases which allowed to clarify our message from the study to achieve better results and avoid complications. Of most importance is an adequate Duplex scan to identify accessory channels and double superficial systems. Reconfirming the catheter tip position after leg elevation is a must. Blind positioning of the catheter must be avoided, as is the advancement of the catheter into the femoral vein to prevent unnecessary intimal damage. Tumescent anesthesia should be instilled below the saphenous fascia and above the deep muscular fascia surrounding the vein using ultrasound guidance. The purpose of tumescence is threefold; analgesia, protecting skin by displacing the vein away from it and neighboring structures against heat (heat sink effect) to displace heat radiating up to 1.5 mm beyond the vein wall, favoring the contact made between the electrode and a dry "saphenous vein" with inflow tributaries eliminated by compression is also created. The GSV should be compressed to separate it from the inflow tributaries, to maintenance an adequate probe temperature in contact with the vein wall. The avoidance of propagation of steam bubbles (or thrombus) by compression is of extreme importance. Further follow up ad studies is needed to improve the efficiency and decrease the incidence of complications of this well-established technique.