Endovenous Radio-frequency Ablation (RFA)

Introduction

What is it?

Endovenous Radiofrequency Ablation (RFA) is a minimally-invasive procedure that uses heat (or ‘thermal’) energy to permanently close the section of the varicose vein being treated. This process is called ablation. An other common variation of thermal endovenous ablation include EVLT (EndoVenous Laser Therapy).

Will I need any preparation?

RFA is often undertaken under local anaesthetic, however you should confirm this with your surgeon. If this is the case you will not have to fast before the procedure. You should check with your surgeon if there are any medications (such as anticoagulation) you should stop beforehand. Many centres ask that you have not had a long-haul (over 4 hours) flight in the 2 weeks before the procedure.

Technique

For this procedure you be asked to lie flat on your back if the Long Saphenous vein is being treated or on your front if the Short Saphenous vein is to be treated.

During the procedure, the surgeon will ask for the bed to be tilted with your head-up or down. This will either be to fill the vein, so it is easier to target, or empty improving the thermal energy treatment. 

Modern varicose vein treatments are often undertaken under local anaesthetic. This often leads to a quicker recovery time following the treatment and means you do not have to fast beforehand. In some circumstances it may be appropriate to undertake the procedure under general anaesthetic, and it is worth clarifying this with the surgeon in your consultation.

The first step is cleaning the leg with antiseptic solution and applying sterile drapes to cover the areas not involved in the procedure. 

The procedure can be broken down into a number of steps: 1. Access to the vein being treated; 2. Positioning of the RFA catheter; 3. Tumescent anaesthesia; 4. Ablation. Each one will be described in turn.

1. Access to the vein being treated.

Ultrasound is used to visualise the exact location of the vein being treated. Once the target vein has been identified they will inject local anaesthetic and use a small needle to access the vein. The needle should be guided by the ultrasound scan to make it as easy as possible. Once the needle is in the vein, a metal wire is passed through the needle into the vein. The needle is then removed and replaced by a narrow flexible plastic pipe called a catheter. In order to fit the catheter into the vein easily, a scalpel may be used to nick the skin. 

2. Positioning of the RFA catheter.

The catheter probe will be placed in the region that requires treating, but away from the main or deep veins. 

3. Tumescent Anaesthesia.

The surgeon will then ask for more anaesthetic called ‘tumescence’. Tumescent anaesthesia is a mixture of local anaesthetic and cold saline. By using a series of injections of the liquid around the vein, the chance thermal damage to the surrounding tissues is reduced. Often the process requires you to be tilted with your head down to ensure spread across the length of the vein. You may feel discomfort during the process, as it can often make the leg feel tight or swollen.

4. Ablation

The RFA probe will be removed at approximately 3 to 5cm intervals to heat along the vein. Once the desired length is treated the instruments will be removed from your leg.

At this stage, if discussed prior to the operation the surgeon may choose to do an adjunctive procedure (see phlebectomies or foam sclerotherapy). 

Post procedure course (follow-up)

The care after RFA will depend on individual practices and needs. Typically, you will be dressed in a full-length bandage which is worn for 1-2 days. You may be given an antibiotic tablet and an injection of an anticoagulant to reduce the risk of infection and deep vein thrombosis (DVT), respectively.

In the days after the procedure you should aim to regularly mobilise. You may also be asked to wear a compression stocking to reduce the risk of DVT. In some circumstances, for example if you have a high risk of DVT, you may be asked to take an anticoagulant tablet or injection following the procedure. Always check the discharge paperwork for detailed post procedure instructions.

How long will I stay in hospital?

As the majority of RFA procedures are now undertaken under local anaesthetic, you will often be allowed to go home on the same day.