The advantages and disadvantages of Radiofrequency Ablation (RFA)
When performed correctly in a suitable vein and under local anaesthesia, radiofrequency ablation (RFA) permanently destroys the vein wall, forcing the body to remove the vein with natural healing processes.
Compared to stripping of the veins, radiofrequency ablation (RFA) uses only tiny incisions against the larger cuts of the stripping procedure. In addition, tying and stripping of the veins is usually performed under general anaesthetic whereas radiofrequency ablation (RFA) should always be performed under local anaesthetic as a “walk-in, walk-out” procedure. Whilst stripping of the veins causes trauma, leading to bruising and in the medium to long term the same varicose veins growing back again, radiofrequency ablation (RFA) causes far less bruising and therefore less pain, and virtually no chance of the treated vein ever growing back again. Therefore radiofrequency ablation (RFA) is much less painful than stripping, has much less bruising associated with it, allows people to return to work again quicker (because of the lack of pain and local rather than general anaesthesia being used), has much smaller incisions and none in the groin giving less chance of wound infection and a better cosmetic result.
The other disadvantage compared to stripping is the need to have a properly trained and experienced professional performing the procedure using very good ultrasound equipment (and preferably a trained and experienced vascular technologist). Stripping is an easier and quicker procedure that is often taught to surgeons as one of their first surgical procedures. As such, most think that they are excellent at doing it. They find it quick and easy and do not have to undergo the complex understanding and training that good endovenous treatments need.
When compared to endovenous laser ablation (EVLA) of the veins, radiofrequency ablation (RFA) is quite similar. They both treat long and straight veins such as the truncal veins. The advantage that radiofrequency ablation (RFA) has over endovenous laser ablation (EVLA) is that the clinic does not have to undergo laser regulations and the patient and staff do not have to wear protective eye wear. Compared to some of the endovenous laser ablation (EVLA) systems that are “forward firing”, radiofrequency ablation (RFA) has much less chance of perforating the vein and causing bruising (ecchymosis). Therefore frequently radiofrequency ablation (RFA) causes less bruising and is less uncomfortable post operatively than endovenous laser ablation (EVLA). However with some of the new radial (or side) firing endovenous laser ablation (EVLA) techniques, there is little or no difference between the two.
The disadvantage of radiofrequency ablation (RFA) compared to endovenous laser ablation (EVLA) is that radiofrequency ablation (RFA) is a contact thermal technique requiring good contact between the radiofrequency catheter tip and the vein wall. Therefore it is less effective than endovenous laser ablation (EVLA) in some cases of very large diameter veins, and veins where the wall might not be in good contact with the catheter tip i.e.; clots within the veins, vein webs or other irregularities of the vein wall.
Radiofrequency ablation (RFA) should not be compared with foam sclerotherapy as the two different techniques should be performed in completely different veins. Unfortunately however, there are an increasing number of phlebologists and doctors that are trying to close long straight veins such as the truncal veins, with ultrasound guided foam sclerotherapy. At the time of writing this, it is clear that foam sclerotherapy is unsuccessful in the medium to long term in veins with a diameter of 6 mm or more, which most of these veins are. Therefore in the veins suitable for radiofrequency ablation (RFA), radiofrequency ablation (RFA) should always be used in preference to foam sclerotherapy for best long-term results.
Different types/versions of radiofrequency ablation (RFA)
As has been alluded to above, the advantages and disadvantages section mainly relates to radiofrequency ablation (RFA) performed with a bipolar radiofrequency device such as the excellent RFiTT.
Most of what has been written is also true for the VNUS ClosureFAST catheter but this system has a further disadvantage. Up until recently, VNUS ClosureFAST was only available in a 7cm end which severely restricted it’s use in small veins or recurrent varicose veins. However VNUS have recently introduced a 3cm version which has got over some of these problems (VENEFIT). With the VNUS RFS device, most veins can be treated – but whereas only one RFiTT device is needed for all of these veins, with the VNUS family, multiple devices (and therefore multiple costs) may be needed.