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Radiofrequency Ablation (RFA) of Varicose Veins


What is Radiofrequency Ablation (RFA) of varicose veins?

Radiofrequency Ablation (RFA) of varicose veins was the first of the new varicose viens treatments to come out. These new treatments are called “endovenous” treatments of varicose veins – or “minimally invasive” surgery or “Keyhole” surgery.

Before endovenous surgery became available, the main way to have varicose veins treated was by stripping.

Radiofrequency ablation of varicose veins uses heat to kill the vein and close it from the inside. Therefore it is also called “endovenous thermablation” – literally ablating the vein with heat from a device passed up inside the vein.

The first radiofrequency ablation device for varicose veins was the original VNUS® Closure® device.

Original Radiofrequency Ablation VNUS Closure catheters 6FG and 8 FG - as used by Mark Whiteley and Judy Holdstock for the first endovenous operation in the UK on 12th March 1999

Original Radiofrequency Ablation VNUS Closure catheters 6FG and 8 FG – as used by Mark Whiteley and Judy Holdstock for the first endovenous operation in the UK on 12th March 1999

Since the orignal radiofrequency ablation devices by VNUS, there have been sevveral more developed. In addition, many varicose vein speicalists have moved away from radiofrequency ablation and on to laser (Endovenous Laser – EVLA or EVLT). endovneous laser is another endovenous device that uses heat.

In 2007 reports of a new radio frequency method for closing the veins very similar to the original VNUS Closure®started appearing. This technique is called RFiTT®.

As with the EVLA and VNUS techniques, RFiTT®is a catheter that is passed into the vein to be treated using a needle under local anaesthetic, and under ultrasound control to ensure it is in exactly the right place.

Just like VNUS Closure®, a radio frequency electric current passes between two electrodes at the end of the catheter, heating the vein wall and destroying it.

The RFiTT® device passes a great deal of energy very quickly into the vein wall, and the early results suggest that the procedure can therefore be performed very quickly.

However, there is a theoretical concern regarding whether sufficient energy is being passed into the vein wall to destroy the vein as with EVLA, VNUS Closure® and Closure® FAST™. All of these techniques put about 60 to 80 J per centimetre into the vein and have shown complete closure and destruction of the vein at this level.

The original recommendations for RFiTT® was to use much lower energy – about 20 J per centimetre into the vein. However prize winning research from The Whiteley Clinic showed that this was wrong and, just like the other methods, RFiTT®  also needed the higher energy levels to be effective: (see Whiteley Clinic research paper: http://www.ncbi.nlm.nih.gov/pubmed/25217038).

In addition to its use in the Great Saphenous Vein, we have already developed its use in the TRLOP procedure. The RFiTT® is now our preferred method of treating perforators with radiofrequency ablation using the TRLOP technique. However, nowadays we usually perform TRLOP using endovneous laser (EVLT).


Summary of Radiofrequency Ablation (RFA) of Varicose Veins:

Although radiofrequency ablation was the first endovenous treatment of varicose veins, and Mark Whiteley and Judy Holdstock were the first in the UK to perform this new treatment, at the Whiteley Clinic we have now moved on to other treatments.

Although we will use radiofrequency ablation in special cases, we now prefer endovenous laser ablation using EVLT to treat varicose veins, with or without phlebectomies, TRLOP, pelvic vein embolisation, ultrasound guided foam sclerotherapy and micro-sclerotherapy.