2 The procedure

2.1 Indications

2.1.1 Symptomatic venous insufficiency is common. Saphenous vein insufficiency is the most common form of venous insufficiency in those presenting with symptoms, which include pain, leg fatigue, oedema, skin changes and venous ulcers.

2.2 Outline of the procedure

2.2.1 Radiofrequency ablation of varicose veins involves heating the wall of the vein using a bipolar generator and catheters with sheathable electrodes.

2.2.2 The long saphenous vein is accessed above or below the knee, either percutaneously via an intravenous cannula/venepuncture sheath or via a small incision. The catheter is manually withdrawn at 2.5–3 cm/minute, and the vein wall temperature is maintained at 85°C.

2.3 Efficacy

2.3.1 Evidence indicated that radiofrequency treatment resulted in immediate occlusion of 90–100% of long saphenous veins. In one study, patients who received radiofrequency ablation had less pain and required less analgesia compared with those who had standard surgery (stripping).

2.3.2 In general, the evidence showed that fewer than 5% of patients continued to have symptoms, such as leg pain, leg fatigue, oedema and noticeable varicose veins, after the procedure. There were high patient satisfaction rates. For more details, refer to the Overview (see 'Sources of evidence').

2.3.3 The Specialist Advisors reported that the long-term results of this procedure were unknown, though in the short-term it seemed efficacious.

2.4 Safety

2.4.1 One study showed similar postoperative complication rates of approximately 50% in the radiofrequency ablation and stripping arms, including minor complications. Other studies showed that skin burns occurred in 2–7% of patients who had radiofrequency ablation. Paraesthesiae occurred in 0–15% of patients, and were more common in patients whose treatment was below the knee. Clinical phlebitis occurred in 2–3% of patients, deep vein thrombosis occurred in 1% and pulmonary embolism was uncommon, occurring in fewer than 1%. For more details, refer to the Overview (see 'Sources of evidence').

2.4.2 The Specialist Advisors reported similar complications to those above.

2.5 Other comments

2.5.1 The Committee noted that there were no long-term follow-up data; treated veins may undergo late re-canalisation.

Andrew Dillon
Chief Executive
September 2003