Overview of Varicose Vein Treatment: Radiofrequency Ablation Therapy
Vein-related diseases are quite common among adults, with about 40% to 80% being affected. These conditions are particularly prevalent in Western countries. It’s noteworthy that in the U.S. alone, more than 30% of adults live with prolonged issues caused by weak veins (chronic venous insufficiency) and twisted, enlarged veins (varicose veins).
Chronic venous insufficiency can not only cause pain, but it can also lead to missed workdays. Over time, these issues can significantly affect a person’s quality of life. There are different methods to treat vein-related issues. Some methods are noninvasive (meaning no incisions or cuts are needed), while others are invasive (requiring procedural or surgical intervention).
The invasive methods of treating vein-related issues include surgeries or procedures done within the veins (“endovenous” techniques). Certain procedures are designed to be minimally invasive, meaning smaller cuts or punctures are created, leading to less discomfort and quicker recovery. These minimally invasive techniques frequently utilize technologies like radiofrequency (use of radio waves to generate heat) and laser therapy (use of concentrated light energy).
Anatomy and Physiology of Varicose Vein Treatment: Radiofrequency Ablation Therapy
The veins in your lower legs can sometimes enlarge and become varicose veins. These bulging, visible veins are larger than 3 millimeters and sit right under the skin, above the leg muscles. Leg veins are categorized as superficial (surface) veins, deep veins, and connecting (perforator) veins.
The main superficial veins are named the great saphenous vein (GSV) and the short saphenous vein (SSV). The GSV starts from the inside edge of your foot, travels under the skin of your inner leg and thigh, and drains into a junction called saphenofemoral in your groin area. Other veins like the superficial circumflex iliac, epigastric, and external pudendal veins also drain into this junction. The GSV can sometimes have two paths in the thigh area in about 20% of people.
The SSV, on the other hand, begins from the outer edge of your foot and usually drains into the popliteal vein, which is located in the back of your knee. Sometimes, the SSV can continue to the thigh to drain into the GSV or the saphenofemoral junction, which can be seen as an uncommon variant called the vein of Giacomini.
Deep veins run alongside the large arteries in your leg. They include anterior tibial, posterior tibial, peroneal, popliteal, and femoral veins. Also, some specific veins from the calf muscles drain directly into the popliteal and posterior tibial veins.
Perforators are the veins that connect the superficial and deep veins, and these are differentiated based on their location in your leg. For example, there are medial, anterior, posterior, and lateral perforators in the leg, and medial thigh, lateral thigh, anterior thigh, and posterior thigh perforators in the thigh. Their function is to interconnect specific superficial and deep veins.
In a healthy vein system, there are one-way valves that ensure blood flows upwards against the force of gravity towards your heart. If these valves become insufficient – that is, they don’t close properly and cause the blood to flow backward – it can be seen on an ultrasound. For superficial veins, a backward flow lasting over 500 milliseconds is a sign of insufficiency. For deep veins such as the femoral and popliteal, it’s over 1000 milliseconds. Veins are typically tested for insufficiency in two ways: increasing the pressure inside the abdomen or applying pressure on distal veins, either by hand or by using a cuff.
Why do People Need Varicose Vein Treatment: Radiofrequency Ablation Therapy
If you’re over 18 and your large veins (more than 3 mm wide) have trouble working properly and aren’t getting better with the use of compression stockings, you may need treatment. This usually involves the veins in your upper and lower legs. Sometimes, ‘connector’ veins (called perforator veins) can also be treated. These are veins that are more than 3.5 mm wide and have unusually high blood flow backward, especially if they are running beneath an active or healed skin ulcer.
The signs of vein problems often include throbbing discomfort, a burning sensation, itching, swelling in the legs, a feeling of heaviness or tiredness in the legs, or spontaneous bleeding from varicose veins. More severe venous disease could result in skin ulcers that heal poorly. Chronic venous disease, a long-term problem with your veins, may lead to skin changes like eczema, corona phlebectatica, lipodermatosclerosis, or a widespread darkening of the skin on the lower legs.
Corona phlebectatica (also known as ankle flare or malleolar flare) refers to tiny veins close to the ankle bone appearing in a fan-shaped pattern on the inner or outer foot.
Lipodermatosclerosis is a condition where the skin thickens and becomes ‘bound’ or stuck to the underlying tissues below the knee.
When a Person Should Avoid Varicose Vein Treatment: Radiofrequency Ablation Therapy
In some situations, it may not be advisable to undergo a particular treatment if you have certain health conditions.
For example, if you have a vein near the surface of your skin that is less than 2 millimeters wide, it may not be safe. Similarly, if you have previously had deep vein thrombosis (DVT) – a serious condition where a blood clot develops within a deep vein in your leg – in the same leg, or if you have an active superficial vein thrombosis (a blood clot in a vein close to the skin’s surface) in the vein that was going to be treated, it might not be advisable to have the treatment. Previous surgical or non-surgical treatments conducted in the same leg, pregnancy, or a known cancer diagnosis may also prevent you from having the treatment.
In addition, if you are generally in poor health, fragile, unable to move around much, or if you have known bleeding or clotting disorders, you might not be able to undergo certain treatments. All these specifics are called contraindications because they may increase the risk of the treatment or procedure.
Equipment used for Varicose Vein Treatment: Radiofrequency Ablation Therapy
Radiofrequency ablation (RFA) is a less complicated treatment procedure for varicose veins. Approved by the Food and Drug Administration (FDA) in 1999, this method uses specially made catheters which contain a tiny heater at the end. In medical terms, this heater is called a “heating element”. The job of this heater is to produce heat (or thermal energy), which effectively damages the thinly delicate layer (known as the endothelium) inside the vein. Depending on different manufactures, the length of the heating element can vary.
Who is needed to perform Varicose Vein Treatment: Radiofrequency Ablation Therapy?
Radiofrequency ablation is a procedure that uses imaging technology and is considered minimally invasive, meaning it’s not a major surgery. You can have it done without needing to stay in the hospital overnight. Local anesthesia is used, which means you’re awake but the area where the procedure is happening is numbed. You don’t need to be fully put to sleep with general anesthesia. This procedure needs a doctor who performs it, a nurse to assist, and a technician trained in ultrasound to help. They will ensure everything goes smoothly.
Preparing for Varicose Vein Treatment: Radiofrequency Ablation Therapy
It’s not usually necessary to give antibiotics before or after the procedure. Typically, patients are made to lie down flat on their back for the treatment. The doctor focuses on the leg that’s giving them problems, and makes sure it is thoroughly cleaned and covered using sterile methods to avoid infection.
How is Varicose Vein Treatment: Radiofrequency Ablation Therapy performed
During your procedure to treat varicose veins using radiofrequency ablation, the doctor will first insert a thin needle into the vein which is causing issues. They do this as close to your knee as possible using ultrasound technology, which helps them see the veins in detail. After they’ve inserted the needle, they then place a device called an “ablation catheter” in the vein. This device is responsible for creating the heat necessary to treat the vein.
Next, an anesthetic solution is injected to numb the area and protect the surrounding tissue during the procedure. This solution might contain adrenaline or epinephrine, bicarbonate, and lidocaine, diluted in saline.
After the anesthetic is added, the doctor uses the ablation catheter to apply heat to the vein. The temperature reaches 120 degrees Celsius and they do this in 20-second intervals until they’ve treated the entire vein.
When the treatment is complete, the doctor will check to make sure there’s no bleeding from where the needle and catheter were inserted. They will then put bandages and compression stockings on your leg. You’ll need to wear these for 1 to 3 days. Their purpose is to minimize any bruising or soreness and encourage blood flow to the area.
After the procedure, you are encouraged to walk. You’ll also likely need to come back for a check-up ultrasound within 1 to 3 days. This allows the doctor to confirm that the vein has closed properly and make sure there’s no damage to the deeper veins in your leg.
After therapy, you’ll probably need to keep wearing the compression stockings. Your doctor will guide you on how long you need to wear them based on your progress.
Possible Complications of Varicose Vein Treatment: Radiofrequency Ablation Therapy
After a medical procedure, undesirable effects or complications can happen as low as 4.4% of the time or as high as 40%. The most common issue that people come across is pain, accounting for more than 95% of these cases. About 10% of cases can involve bruising or inflammation of a vein, a condition known as thrombophlebitis. As for infections in the area where doctors performed the procedure, they only happen in 0 to 5% of cases. Major issues such as injuries to a nerve, a lung blood clot (pulmonary embolism), or a deep vein clot (DVT) are much less common, happening in less than 1% of cases.
What Else Should I Know About Varicose Vein Treatment: Radiofrequency Ablation Therapy?
Research has shown that a procedure called radiofrequency ablation (a minimally invasive procedure that uses radio waves to reduce or eliminate pain), often leads to fewer complications and side effects compared to other treatments. Not only that, patients who undergo this procedure report feeling better and enjoying a higher quality of life for up to a year after the treatment.
