Radio Frequency Ablation (RFA) utilises a thermal-based catheter, using radio-frequency energy, to heat seal the vein. It requires the use of local anaesthetic tumescent along the length of the treated vein to dissipate the thermal energy, protect the saphenous nerve and sural nerve that run with the GSV and SSV respectively and provide initial analgesia. When compared to surgical stripping, initial occlusion rates and longer term (1-3 year) recurrence rates for thermal endovenous ablation (RFA or EVLA) are similar to or better than surgical stripping in numerous randomised control trials and meta analyses[11, 16]. RFA has demonstrated lower post-procedural pain and bruising, when compared to EVLA and results in earlier return to normal activities[11].
A technical limitation of RFA is that it is mainly used for main truncal (GSV/SSV) ablation, whereas perforator veins require other treatment options.
Complications from RFA include[11]:
- thrombophlebitis (which is the most common complication of RFA), occurring in up to 14% of patients, due to inflammation of the treated vein. This commonly presents within the first month, is self-limiting and responds to non-steroidal anti-inflammatories (NSAIDs) and other simple analgesia agents.
- bruising and haematomas, however at rates less than surgical stripping.
- DVT, which is reported in up to 7.8% in some series and is commonly due to heat-induced thrombus extension at the saphenofemoral junction. The role for pharmacologic prophylaxis is unclear but is recommended for high-risk patients. Treatment with therapeutic anticoagulation is indicated when the thrombus extends into the common femoral vein.
- thermal injury and paraesthesia occurs in 1-2% of cases, as the energy dissipates through adjacent tissues.
- hyperpigmentation.