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Radiofrequency ablation (RFA)

Radiofrequency ablation (RFA) is a method of dealing with varicose veins

Radiofrequency ablation, RFA, is a method of dealing with varicose veins. Such varicose veins, varicoses, are common enough, some 30% of people or a third of the population will get at least one over a lifetime. They become more common with age.

There's usually no specific cause, they're just one of those things that happen. Not all parts of the body have quite caught up with the adaptation from four legs to only two, the blood circulation system in the legs being one of them.

Treatment of varicose veins has been going on for a long time we have records from Ottoman, Byzantine and even Roman times. One Emperor was treated and remarked that the result was not worth the effort. His were treated by extraction without the aid of anaesthesia, and he might have been right.

Treatment has advanced considerably and radiofrequency ablation is the current standard. Ablation means to treat using heat, radiofrequency alternating current is the method of applying that heat. An older method was to use a laser.

The cause of the varicose is that the surface veins (superficial veins more properly) are allowing blood to pool, travel in the wrong direction, move both ways or other results from a deformed or deficient valve. The solution is to block off that divergent pathway.

Radiofrequency ablation is minimally invasive surgery that is this solution. A small catheter is inserted into the relevant vein and then the heat comes from electrical current at 350 to 500 kHz which is where the radio part of the name comes from. This causes the vein to contract and close.

The initial requirement is that there be varicose veins to be treated. The second is the desire to treat them.

In themselves, varicose veins are usually physically harmless. Some radiofrequency ablation is carried out for cosmetic reasons – we don't have to have varicose veins, so why should we?

However, more common is that, while not harmful, varicose veins can cause pain and itching – over and above not wanting them to show in warmer weather when shorter clothing is worn. It is possible for varicose veins to be susceptible to phlebitis, that is painful inflammation. RFA, by closing off the veins, can remove those physical symptoms.

More rarely, varicose veins can cause something called varicose eczema and possibly skin ulceration. At which point radiofrequency ablation can be carried out to remove the cause of these problems. Finally, as varicose veins become more widespread they can cause damage to the skin itself, especially about the ankles.

The necessity for RFA, or other varicose vein treatment, lies on that spectrum. From being a cosmetic desire through removing pain and itching up to something that prevents further damage to the skin.

RFA can be carried out under either local or general anaesthetic, this is something to discuss with the consultant. It is always conducted in a theatre, not a consulting room or office, and is near always a day treatment.

The first stage for radiofrequency ablation is the planning of it. This is done by using duplex ultrasound vein mapping. This is a method of tracking exactly where the veins are and where the difficulties lie. Where is there the reverse flow, or possibly dual direction movement of the blood?

There is more to this than merely observing the surface discolouration of the skin. DUVM uses Doppler techniques to measure speed and direction of flow throughout the venous system under examination. With this information about reflux – misdirections in the blood flow -  it is possible to exactly plan the interventions necessary.

Radiofrequency ablation itself is usually completed in under an hour. A very small catheter – a tube - is inserted into the leg though a puncture site, the incision being perhaps ¼ of an inch or half a centimetre. Then the actual process of RFA itself.

A low level of current, but at those radiofrequencies, is used to heat the vein itself. This causes it to contract and close. This closure then stops that diversion, or even circular movement, of the blood which was causing the varicose.

As a minimally invasive procedure, radiofrequency ablation has a short recovery time. The option for a general anaesthetic over a local will increase this, of course.

The size of the incision means that a return to normal activities is usually recommended after only 24 hours. Heavy lifting or strenuous exercise should be avoided for a week or so.

There will be some bruising and swelling, this is an invasive procedure, however minimal. These will go within 10 to 14 days.

Compared to other methods of treating varicose veins the recovery time from RFA is minimal.  

There is the rare possibility of RFA treatment causing deep vein thrombosis (DVT). This elevated risk lasts for perhaps a fortnight and then returns to normal. On the other hand, significant varicoses can themselves be a cause of DVT, so there's a balance of risks to treatment and non-treatment.

If a general anaesthetic is chosen then there will be the usual risks associated with that.

One major risk is that the ablation simply will not work. It does in about 90% of cases but that still leaves 10 out of a hundred where it doesn't, or not perfectly. RFA can be repeated or another varicose vein treatment chosen.

It's possible to worry about what happens when a vein is closed off. What then happens to blood flow? The legs have two different blood supply systems, the deep and the shallow (or superficial). Varicose veins are in that superficial system and closing them off is not problematic. The two systems have many connections and cross over points – they're better thought of as an interlocking network. Blood supply will work around the treated varicose and all areas of the legs will still gain their necessary amount.

With any invasive procedure it is possible that nerves will be damaged. This can lead to numbness even after full recovery. The likelihood with RFA is reduced from other possible varicose vein treatments.

It is possible for varicose veins to return even after treatment. This is unlikely to be an actual return though. The radiofrequency ablation is a complete treatment for a specific vein. However, the factors that led to varicoses in the first place can then lead to others and or more at some future date.

The return is therefore more occurrences of the same problem, not a reoccurrence of the first one. Treatment can be done again on these new instances.

Specialists offering Radiofrequency ablation (RFA)

Mr Stephen Paul Cavanagh

Consultant Vascular Surgeon

MBChB, MD, FRCS(Gen)

BMI The Duchy Hospital

View profile Book online

Mr Jonathan Ghosh

Consultant Vascular & Endovascular Surgeon

MB ChB, PGD Med Ed, MA, MD, FRCS

BMI The Alexandra Hospital

View profile Book online

Dr Jawaharlal Senaratne

Consultant General & Vascular Surgeon

MB, BS, MS, FRCS (Eng), D.Phil (Oxon), FRCS (Gen Surg)

BMI The Chaucer Hospital

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Mr Maher Hamish

Consultant General and Vascular Surgeon

MD, MSc, EBTS, EBVS, FRCS

BMI Three Shires Hospital 1 more BMI The Clementine Churchill Hospital

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Mr Michael Gaunt

Consultant Vascular Surgeon

BSc (Hons), MB ChB(Dist), MD (Dist), MA (Cantab), FRCS (Eng)

BMI St Edmunds Hospital

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