Radiofrequency ablation: evolution of a treatment

Superficial venous insufficiency of the lower extremities is a common affliction. There are several modalities available to the clinician to treat this problem. This article specifically examines the technique of radiofrequency ablation in the treatment of superficial venous insufficiency. The evolution of the catheters used in radiofrequency ablation is discussed in detail. The mechanism of action of the radiofrequency energy on the vein wall is explained. Several technical aspects of the technique, such as temperature set point and pull-back speed are described. The importance of tumescent anesthesia and its role in reducing complications are illustrated. Short- and long-term results of radiofrequency ablation are compared to results with both operative therapy or endovenous laser therapy, the results are similar if not better. Complications of radiofrequency ablation therapy are discussed, emphasizing the advent of tumescent anesthesia and the resultant drop in paresthesias. Outcome analysis of radiofrequency ablation is shown to have positive effects on both clinical-etiologic-anatomic-pathophysiologic class and venous clinical severity score. Finally other considerations, including billing and necessary supplies, are summarized. In summary, radiofrequency ablation is shown to be a safe and effective modality in the treatment of superficial venous insufficiency.