Percutaneus treatment of varicose veins with bipolar radiofrequency ablation

Abstract 

The traditional surgical treatment of an incompetent great saphenous vein (GSV) and small saphenous vein (SSV) is challenged by endovenous techniques. Bipolar radio frequency induced thermo therapy (RFITT) is a new endovenous treatment, which occludes the vein by using the venous wall as a conductor.

Linear endovenous energy densitiy (LEED) describes the amount of energy used for vein closure.

Material/methods

From March 2007 till April 2009, two cohorts (23W and 20W) were compared, respectively 280 and 178 patients. GSV and SSV were separately analyzed. Follow-up was performed at 3 weeks and 1 year post-operatively with duplex ultrasound, to assess vein closure and perioperative complaints. A visual analog scale (VAS) pain score (range 0–10) was documented. For patients operated after October 2008 follow-up was performed at least 6 months after surgery.

Results

528 GSV and 76 SSV were treated. For the GSV a significant difference in LEED 40.8 17.1 in the 20W cohort was found, resulting in higher occlusion rates 90.6% compared to 82.7% after 3 weeks. Follow-up of 1 year in the 20W cohort showed 88.7% occlusion. Multivariate analysis showed that pullback speed (OR 3.7, CI 1.1–12.4) and CEAP classification (OR 3.1, CI 1.7–5.6) were significant predictors for vein occlusion. Despite a higher LEED, post-operative complaints were not significantly worse.

Conclusion

RFITT is a safe and effective method to treat incompetent saphenous veins. Slower pullback speed with higher LEED results in higher closure rates without causing more pain.

Keywords: RFA, Varicose veins, Echo