Endovenous radiofrequency therapy
The radiofrequency ablation (RFT) or endovenous radiofrequency ablation (RFA) is a minimally invasive or operationsersetzende method for the treatment of varicose veins .
Action
The method is similar to endovenous laser therapy . The deliberate damage to the diseased vein occurs here through the application of heat using radio waves . For this purpose, the skin is punctured in the area of the lower leg . A probe (2-3 mm) is inserted into the trunk vein and advanced up into the groin or the hollow of the knee. If the probe is placed in this way, the radio wave energy is applied to the vein wall at the upper end of the probe, which is now in the vein . The radio waves heated the inner wall of the varicose vein to approx. 120 ° C and closed it. When the probe is withdrawn through the trunk vein from top to bottom, the varicose vein heats up internally and shrinks. The entire process takes about three minutes.
The treated vein becomes stuck after the treatment, which closes the vein and prevents the pathological backflow of the venous blood (reflux). The blocked vein initially hardens, then completely recedes over the course of a few months and is broken down by the body. Endovenous radiofrequency therapy is carried out on an outpatient basis under local anesthesia . Usually, the patient can resume his usual activity immediately after the procedure.
history
Endovenous radiofrequency therapy was originally practiced by AC Sztankay and published in 1984. The electrical obliteration of the varicose veins was carried out with the help of high-frequency diathermic current on well-selected patients. A good result was achieved in 90 percent of the patients treated in this way. The particular advantage of the method lies in the complete emptying of the vein, which makes the stab incisions superfluous, and in the fact that the procedure is free of complications.
On the other hand, the chemical treatment in the vein causes endothelial irritation, sterile phlebitis, as a reaction to the injected agent . The blood that has coagulated in the lumen (“intravaric hematoma”) stores hemosiderin in the venous wall in the perivenous connective tissue . The hemosiderosis caused by the deposit can cause noticeable discoloration of the skin. This hemosiderosis later turns into a real pigment deposit. Complications are possible with chemical procedures (allergy, anaphylactic shock , tissue infiltration and induration, up to tissue necrosis , ulcer, etc.). In extreme circumstances, thrombosis of the deep leg veins or pelvic veins can also occur.
To avoid these complications, a new method has been developed: electrical obliteration of the varices. This procedure is based on the hemostatic effect of the high-frequency current. A cannula inserted into the varicose vein to be sclerosed serves as a working electrode after gently isolating the skin. The wide neutral plate completes the circuit. The intravascular electrode transfers the current to the flow and to the endothelium. There is almost no flow through the perivenous tissue at all, as the blood (also as an electrolyte solution) - in contrast to the perivenous connective tissue - has the lowest electrical resistance. A special cannula is used, the shaft of which is insulated, only metallic at the tip, which does not allow any electrical contact with the skin and subcutaneous tissue. When the power is switched on, the patient can still feel warmth; it is therefore advisable to infiltrate the area around the cannula subcutaneously with anesthetic immediately after the venipuncture has taken place. Electrical sclerotherapy is not possible with pacemaker wearers .
Endovenous radiofrequency therapy has been marketed since 1998 by the Californian manufacturer VNUS Medical Technologies, Inc under the name VNUS-Closure . Around 2007 it was abandoned by VNUS due to the extremely long duration of treatment and replaced by a purely thermal method with a tubular heating wire, the closure-fast method. A further developed, genuine endovenous radiofrequency therapy (RFITT) has been offered by Celon (a 100 percent subsidiary of Olympus Medical ) since mid-2007 . This method is very fast, only heats the inner walls of the varicose veins to lower temperatures of about 90 ° C and is therefore very gentle and almost painless for the patient. There is also almost no postoperative pain.
swell
- Medical practice: The doctor's newspaper in clinic and practice . XXXVI. Volume, No. 94 (pages 2829/2830) of November 24, 1984.
- JC Ragg: Comparison of radio wave and 810nm laser in the saphenous vein of the same patient. Wiener Medical Wochenschrift, Suppl. 123/10, Abstracts Venalpina IV
