In clinical trials, RF ablation for varicose veins and spider vein treatment has proven to be safe and effective for truncal veins. More importantly, they have proven to be associated with better long term results, faster recovery and improved quality of life in comparison to older, dated methods like surgical stripping. The modern day minimally invasive techniques for vein treatments have been revolutionary.
What Are Varicose Veins?
Varicose veins are abnormal swollen veins present both on the surface and beneath the surface of the skin. In contrast, spider veins are smaller, red or purple blood vessels that are <1 mm in diameter and have a web-like appearance. Both conditions can be related to venous insufficiency prompting a visit to vein clinic
What creates Varicose Veins problems?
The normal function of leg veins is to bring blood back to the heart. With activity, the calf muscles function as a pump, to circulate blood back from the legs toward the heart. The same blood vessels have one-way valves that protect against blood from reversing back due to gravity. If the valves are faulty, this mechanism fails and blood collects in the lower legs resulting in venous insufficiency. This abnormal flow is referred to as reflux and with time builds up pressure in the legs to cause symptoms including abnormal spider and varicose veins.
Who is at risk of Varicose Vein disease?
There are various risk factors associated with varicose veins. These dangers include a family history of varicose veins, obesity, pregnancy, hormonal adjustments at menopause, a job that requires prolonged standing or sitting, and even previous trauma.
What Is the Most Effective Varicose Vein Treatment?
The mostly commonly used device used by a phlebologist is the RF ClosureFAST by Medtronic. The ClosureFAST system is based on radiofrequency, thermal induced destruction of vein walls similar to the concept of laser treatment for spider veins.
Procedure
Radiofrequency RF vein ablation is minimally-invasive and can be performed directly in the office. The best vein clinic perform the procedure in a dedicated room that provides a sterile environment and houses the necessary equipment. In general, thermal ablation is utilized for truncal veins like the GSV and SSV or some of the tributaries.
Access for the ablation catheter is obtained by venupuncture under ultrasound guidance. Prior to access, the area of treatment should be sterilely prepped and draped per usual protocols. Lidocaine or similar local anesthetic is used to numb the region of interest. Using the modified Seldinger technique, the vein is prepared for treatment with exchange of wires for a percutaneous sheath.
In the case of the GSV access can be obtained anywhere distal to the SFJ (or in the case of the SSV, distal to the SPJ) that provides adequate treatment of the culprit vein. The ablation catheter is then advanced into its target position under careful ultrasound guidance making sure that any positioning into deep venous structures is avoided. Before the heat sources is turned ON, the saphenous sheath in the region of interest is infused with diluted tumescence anesthetic (combinations of lidocaine, saline, bicarbonate, and epinephrine). Epinephrine is used sometimes opted for by the vein specialist in the solution to minimize the vein size when treatment is performed. Tumescence has three purposes: 1) anesthetic 2) collapse the targeted vein to the size of the catheter where treatment can be more effective against the venous walls, and 3) direct collateral tissue and nerves away from the targeted region to reduce risks of injury.
Once adequately anesthetized, the vein doctor will activate the RF generator and heat the tip of the catheter. The catheter will then be withdrawn 6.5cm with each treated segment until the catheter has fully treated the targeted segment and can be withdrawn in entirety from its insertion site. The sheath is also withdrawn and hemostasis at the access site is achieved by manual pressure. Post procedure after care instructions are then provided to the patient by the vein treatment clinic per usual protocol.
At minimum, the patient will return to the vein specialist with in 1 week to rule out any unintended complications, like DVT. Thereafter, each vein clinic follow their own protocol to assess the need for additional treatments based on any continued symptoms.
Overall success rates for RF vein ablation is >90% in long term follow-up with fearsome complications like DVT or allergic reactions in the proper hands of a qualified vein specialists near me being less than 1%.
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