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Radiofrequency saphenous ablation – A new minimally invasive treatment for saphenous reflux and varicose veins

Estimated to afflict more than 25 million American adults, superficial venous insufficiency, also called saphenous vein reflux, is caused by a malfunction of the valves in veins that prevent blood from reversing direction and pooling in the vessel. The saphenous vein runs up the leg from the ankle to the groin and is responsible for returning oxygen depleted blood to the heart.

When the valves in saphenous veins become weakened and blood begins to pool, increased pressure builds in the veins of the leg. Branches of the saphenous vein dilate in response to the increased blood pressure. Over time the branch veins enlarge and develop a bulging, snakelike pattern down the legs that is visible under the surface of the skin. These bulging veins are called varicose veins. Most, but not all, cases of varicose veins are related to saphenous vein reflux.

Though most cases of venous insufficiency and varicose veins occur in women, men also develop the condition. The initial cause of the disease has been linked to a number of factors, including genetic predisposition, pregnancy, prolonged standing, excess weight and inadequate exercise.

Although for some patients, varicose veins are merely a cosmetic nuisance, the condition can lead to serious complications with debilitating symptoms. Long term venous insufficiency can lead to pain and swelling that makes walking or standing for long periods of time difficult. Other symptoms include chronic fatigue of the legs or the development of leg ulcers.

The initial and primary therapy for saphenous reflux and varicose veins is external compression stocking therapy. Properly fitted compression stockings can reduce the chance of disease progression, and patient symptoms will often be improved. However compression stockings may not provide adequate relief for some patients, and some cannot tolerate the stockings. In the event of failure of compression therapy, surgical intervention may be necessary.

Traditionally, the treatment of saphenous reflux meant surgical excision, or stripping, of the saphenous vein. The procedure is effective but it requires at least two incisions and it is associated with significant bruising and pain. Many patients stay off work for 2-3 weeks after stripping.

Radiofrequency ablation, which is now performed at Allegheny General Hospital, is a relatively new procedure which employs radiofrequency energy to occlude, or close, the saphenous vein and is performed through one small puncture near the knee. After locating the vein via ultrasound imaging, physicians thread a small electrode-tipped catheter through the length of the vessel. The passage of radiofrequency energy through the vein wall as the catheter is withdrawn causes resistive heating, which shrinks the vessel, collapsing it and eliminating any further valve leakage. The technique takes approximately one hour to perform, requires no general anesthesia and patients are generally able to resume normal activity in a few days.

A number of peer-reviewed clinical studies over the past few years have underscored the advantages of radiofrequency ablation over the traditional surgical approach. Recently, results from a multi-center randomized trial comparing recovery rates and quality of life between patients treated with conventional vein stripping and those treated with radiofrequency ablation was published in the Journal of Vascular Surgery (August, 2003). The study found that those undergoing the newer procedure experienced less post-operative recuperation time, faster return to work and normal activities and less post-operative pain and limitation of physical activity.
 

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