Radiofrequency ablation of veins

Radiofrequency ablation (RFA) of varicose veins is one of the endoluminal treatment methods. It has been widely used forover 10 years. Today it is considered to be one of the methods in the treatment of insufficiency of magnasaphenous vein (VSM) and saphenous vein parva (VSP), the most common cause of varicose veins in the legs.

In recent years, sophisticated probes that emit radiofrequency waves have been perfected. Interacting with the inner surface of the vein wall,radiofrequency waves release heat which leads to destruction and causes thevein walls to stick together (RFITT - Radiofrequency Induced Thermotherapy), resulting in the closure of the vein. In the first RFITT system, the procedure takes up to half an hour.It is also known as the Celon method of treating varicose veins after the subsidiary of Olympus that manufactured the device. Their engineers have constructed a system for the rapid RFITT. This system of RFITT procedure takes about 20 to 60 seconds. Theresults of the international study were shown at the congress of the European Society for Vascular Surgery, held in Madrid in 2007, and in two papers published in two eminent phlebology magazines, (which was also attended by Dr. Ajduk). It turned out thatthe system for the rapid RFITT can treat superficial venous insufficiency with excellent results and with great aesthetic effect.

The RFITT procedure is relatively simple. Radiofrequency probe is introduced into the vein either percutaneously, or through a small incision. This opening affords room for a microscopic probe, which is guided upward to the saphenous vein. Ultrasound images guide the probe. No radiation is used because this therapy is minimally invasive and nonsurgical and it can be performed under local anesthetic.

Prior to the application of radiofrequency ablation,so-called tumescent anesthesia (diluted local anesthetic) is injected along the entire vein. In addition to acting analgesic, tumescent anesthesia compresses the vein in order to achieve optimal contact ofthe probe with the vein wall.Once the probe has reached its target, and having applied tumescent anesthesia, the procedure of RFITT can commence. The probe is connected to the appropriate device that controls it. By pressing the pedal, the probe emits pulses of heat, generated by radiofrequency waves. At the same time the probe is withdrawn at a rate of about 1.4 sec / cm. The process is monitored by a device that emits a beep notifying the operator that the speed of probe withdrawal is optimal.
The great advantage of this system for fast RFITT to other endovenous methods is that it does not allow the release of excessive heat that could damage the other structures besides the veins, like the nerves and skin. However, if there is such a danger, the operator is informed by a changing tone, while the probe shuts itself off. Depending on the length of the treated vein segment, RFITT procedure takes about one minute. Remaining branch varicose veins are treated inthe traditional way (through an incision of a few millimetres with the aid of specially designed hooks) or treated by foam sclerotherapy.

The RFiTT system results in significantly lower levels of post-operative discomfort or complications in comparison to conventional vein stripping (pulling out the vein using metal or plastic wire or probe). When using the RFiTT system, veins are not physically removed,which makes the whole procedure less traumatic.

In the aforementioned study, in addition to objective indicators (Doppler Tracking),patient satisfaction was monitored as well. Almost all patients were extremely satisfied with the procedure and they all stated that they wouldrecommend this method to friends with similar problems.

In order to get such good results, and to make patients satisfied with the treatment, it is necessary that the operator who performs the procedure has the appropriate training in the application of RFITT.



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25.03.2013.

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