What is the role of radiofrequency ablation in the treatment of varicose veins and spider veins (telangiectasia)?

Updated: Feb 28, 2018
  • Author: Robert Weiss, MD; Chief Editor: William D James, MD  more...
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Answer

Radiofrequency ablation is a thermal ablation technique that uses a specially developed proprietary RF catheter placed inside the vein. The first version was cleared by the FDA in 1999. The most recent version using a redesigned simpler RF catheter was introduced into the market in 2007.

A cutdown, stab incision with vein exteriorization, or simple needle puncture using a Seldinger over-the-wire technique is used to place an introducer sheath into the truncal varix to be ablated.

A special RF ablation catheter is passed through the sheath and along the vein until the active tip is at the saphenofemoral junction just distal to the subterminal valve. Position of the tip is confirmed by ultrasonography.

Tumescent volumes of local anesthetic are injected in quantities sufficient to separate the vessel from the overlying skin and other delicate tissues along its entire length.

In the old system, metal fingers at the tip of the RF catheter were deployed until they made contact with the vessel endothelium. In the new system, 7 cm of the tip is heated to 120 º C using RF energy. Tissue heating occurs both in and around the vessel to be treated.

Thermal sensors record the temperature within the vessel. Energy is delivered until the tissue temperature is just sufficient to ensure endothelial ablation.

The RF catheter is withdrawn every 7 cm and the process is repeated all along the length of the vein to be treated.

While widely accepted, there remains a lack of long-term, high-quality trials and class 1A evidence comparing RF ablation efficacy with open surgery. [17]


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