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Venous Radiofrequency Ablation

VNUSR Cosure or Endovenous Radiofrequency Ablation is a minimally-invasive technique for the treatment of patients with symptomatic varicose veins and chronic venous insufficiency. Born as an alternative to the traditional stripping operation, it is now frequently used in the office setting  to treat the great or small saphenous veins, as well as perforators and large venous branches. The technique is very effective in eliminating incompetent veins and has fewer complications than traditional stripping. It is very similar to Laser (EVLT) as it is performed with comparable modalities and has very similar results. No Laser is used here.

Principle. A radiofrequency catheter is inserted into the vein, the radiofrequency energy delivered, which causes the vein to heat up and shrink
until it shuts close. This diverts blood flow immediately to nearby healthy veins.

Technique. These procedures are performed by specially trained physicians such as vascular surgeons. A topical anesthetic is applied over the  vein to be treated  before the procedure. The leg is prepped sterile and  covered with a surgical drape. A very small incision is made in the skin and under ultrasound guidance, the catheter is inserted through the skin into the vein. A solution containing local anesthetic is injected around the  vein with ultrasound and radiofrequency energy applied as the catheter is withdrawn. The procedure takes 30-45 minutes, no general anesthesia or sedation is required, it is associated with mild discomfort, no stitches are applied. 

Post-procedure care. Following the procedure, a graduate compression stocking is applied to prevent bruising and inflammation. Most patients report significant improvement from symptoms and can return to normal daily activities immediately. Air travel or prolonged sitting should be avoided. A follow-up ultrasound is generally obtained 3-5 days after the procedure. 

Complications. Very tortuous veins may not be able to be accessed by the catheter because of turns and bends, and the procedure may need to be aborted; these cases are best treated by conventional stripping. Some postoperative bruising and tenderness may occur, which improves over the next few days. There is a very small risk of infection (less than 0,1%) . Heat can cause damage to the small nerves, which generally disappears over a short period of time. The treated vein can become inflammed (thrombophlebitis), but it generally responds to anti-inflammatories. Blood clots may form in the veins, which generally respond to blood thinners (travel to the lungs is exceedingly rare).