What is Radiofrequency Ablation?
Radiofrequency ablation (RFA) is a minimally invasive (keyhole) procedure that uses heat generated from radiofrequency energy to collapse the walls of varicose veins, causing them to shrink and close shut.
Once the vein is closed, blood will naturally re-route to other healthy veins.
The procedure is usually carried out under local anaesthetic and takes around 45-60 minutes.
Are my varicose veins suitable for RFA?
A high proportion of patients with varicose veins are suitable for RFA. Suitability is determined by clinical assessment with Doppler scan and/or Duplex ultrasound.
Some patients are best treated by surgery, particularly those with very extensive large varicose veins or certain complications.
Others may be best managed with foam sclerotherapy e.g. those with recurrent (or residual) VVs after previous treatment with RFA or surgery, or those who just involve isolated smaller veins in the leg.
Following assessment with Doppler and/or Duplex ultrasound, Mr Abu-Own will discuss with you the options for treatment for your individual case to help you come to your decision on what is the best treatment for you.
What are the benefits of RFA?
It is a minimally invasive treatment alternative and therefore is associated with less pain and less bruising when compared to traditional vein stripping surgery. The tiny, ¼ inch incision away from the groin used in RFA can treat an entire vein up to 30 inches. This gives a smaller chance of a wound infection and a better cosmetic result.
Patient satisfaction with results of treatment is generally very high for RFA. Only a small proportion of people continue to have symptoms such as leg pain, leg tiredness, swelling and noticeable varicose veins after the procedure.
What does the procedure involve?
An ultrasound scan (US) is performed and the veins to be treated are marked with a pen. You lie on a couch and your leg is cleaned and covered with drapes. Depending on which veins are to be treated, you may be on your back or your front.
A small amount of local anaesthetic is injected into the skin over the vein. Your surgeron will insert a radiofrequency ablation catheter into the diseased vein using a percutaneous (through the skin) technique under US guidance. They will use US to guide them to the correct position where the diseased superficial veins meet with the deep veins of the leg. They will inject a special liquid containing local anaesthetic to squash the walls of the vein onto the catheter (tumiscent anaesthesia).
The catheter has an electrode that heats the walls of the veins using radiofrequency energy. Your surgeon will slowly remove the catheter while radiofrequency energy is sent down the electrode. The radiofrequency energy will cause the diseased superficial vein to close. The blood will be re-routed naturally to the deep veins.
Your surgeon may need to remove other varicose veins through small cuts (phlebectomies) or close them using foam injections. Your surgeon will remove the catheter and cover any cuts with a dressing. You will be given a compression bandage or stocking to wear.
If you have RFA under local anaesthetic, your surgeon may not be able to remove all of the varicose veins during the procedure. These can be treated subsequently by foam sclerotherapy as an outpatient procedure under local anaesthesia.
What happens after treatment?
Following the procedure, a compression bandage or stocking is applied.
Risk of DVT following this treatment is very low, but you may be given an injection to reduce the risk even further - this will depend on the results of your thrombosis risk assessment.
You should expect to go home later the same day. It is advisable not to drive home, so make your prior arrangement for transport.
A bandage may be applied initially, especially if phlebectomies were performed. Mr Abu-Own normally advises his patients to keep these bandages on for two days and to use the stocking thereafter for up to two weeks.
You will be given instructions about how to bathe. You can shower and dry but you cannot swim during the period in which you have been advised to wear the stockings.
You should be able to go back to work straight away and get on with most normal activities. Your surgeon may encourage you to walk frequently and avoid standing or sitting for long periods.
Some patients experience a tightening sensation along the length of the treated vein and some get pain in that area around 5 days later, but this is usually mild. Simple pain-relief medications like paracetamol and anti-inflammatory medications like ibuprofen normally provide suffient relief.
Will I need further treatment?
If you are having RFA treatment simply to relieve symptoms then no further treatment is usually necessary, as the symptoms will resolve in the vast majority of cases.
However, we understand that many patients seek treatment because they wish to improve the appearance of their veins, and of these a significant proportion would require further treatment if RFA is used alone.
For this reason, Mr Abu-Own personally recommends carrying out additional phlebectomies at the same time as carrying out RFA to reduce the need for follow up treatments. Phlebectomies (avulsions) are undertaken after local anaesthetic solution has been injected around the veins to numb the area. Small incisions are made over the veins and they are teased out with a crochet hook. You may require many small incisions but they usually heal very well without stitches and are typically not visible at one-month follow-up.
Please note that if you have extensive varicose veins on both legs it is very unlikely that you will be able to have all the additional treatment undertaken at the time of the RFA.
If additional follow up treatment for residual varicosities is required, that is is usually provided by foam sclerotherapy. These additional treatments can be undertaken after a delay of several weeks. Foam sclerotherapy is the commonest means of dealing with residual varicose veins after RFA and is highly effective for these.
What are the complications of RFA?
Serious complications after RFA are very rare.
Thrombophlebitis: RFA works by heating the wall of the vein and an inevitable and deliberate response to the heat is an inflammation of the vein wall. You may feel the vein that has been treated become hard and tender. Varicose veins that feed from the treated vein may also become hard and lumpy as some blood clot forms within them. This clot is not dangerous and your body will naturally absorb it over weeks.
Nerve damage: As nerves can lie alongside the veins these may also become damaged by the heat or by avulsions and a few patients notice small patches of numbness on their skin. These usually resolve over a few months.
Burns: Although it is possible to burn the skin in practice this is very rare indeed.
DVT: A DVT is a blood clot in the deep veins in the leg. The risk of getting a DVT after RFA is very low but has been reported.
What are the drawbacks of RFA?
- RFA requires a high level of training and expertise with access to advanced equipment. Consequently, not all surgeons or clinics will be able to offer you this treatment option.
Not all varicose veins qualify for treatment with RFA. This method is best used to treat the major superficial veins and is generally unsuitable for the treatment of recurrent varicose veins following previous surgery. Other treatments such as surgery or foam sclerotherapy may be more appropriate for your individual case.
There is a small chance that thermal damage to nerves in the skin may occur due to the heating effects of the treatment. This is usually temporary (see complications below).
Are there any follow-up consultations?
Mr Abu-Own routinely sees his patients at least once for a consultation following radiofrequency ablation procedures, usually around 2-4 weeks after the procedure. For self-funding patients, this is included in your pre-agreed all-inclusive procedure price.