Tumescentless endovenous radiofrequency ablation with local hypothermia and compression technique

Abstract

IntroductionModern surgical management of chronic venous insufficiency is possible since the development of catheter-based minimally invasive techniques, including radiofrequency ablation (RFA) and the application of colour Doppler sonography. RFA technology requires the use of tumescent anaesthesia, which prolongs the operating time. Instilling tumescent anaesthesia percutaneously below the saphenous fascia is the steepest part of the learning curve. In our study, we compared operative and postoperative results of tumescentless RFA and RFA with tumescent anaesthesia, to investigate the necessity of tumescent anaesthesia.MethodsA total of 344 patients with Doppler-confirmed great saphenous vein insufficiency underwent RFA between January and December 2012. Patients were divided into two groups according to anaesthetic management. Group 1 consisted of 172 patients: tumescent anaesthesia was given before the ablation procedure, and group 2 contained 172 patients: a local hypothermia and compression technique was used; no tumescent anaesthesia was administered. The visual analogue scale (VAS) was used and ecchymosis scores of the patients were recorded. Clinical examinations were performed at each visit and Doppler ultrasonography was performed in the first and sixth month.ResultsMean ablation time was significantly lower in group 2 compared to group 1 (7.2 vs 18.9 min; p < 0.05). Skin burn and paresthesia did not occur. The immediate occlusion rate was 100% for both groups. No significant difference was found between the groups in terms of VAS and ecchymosis scores. All patients returned to normal activity within two days. The primary closure rate of group 1 was 98.2% and group 2 was 98.8% at six months, and there was no significant difference between the groups (p > 0.05).ConclusionEliminating tumescent infusion is a desirable goal. Tumescentless endovenous RFA with local hypothermia and compression technique appears to be safe and efficacious. Our technique shortens the operation time and prevents patient procedural discomfort.

A comparison of four different endovenous ablation techniques

“…[5,6,10,14] In a previous study, we published our satisfactory and encouraging results with the tumescentless RFA. [16] Based on our findings, we suggest that RFA and EVLA are both appear to be effective for the treatment of GSV insufficiency. However, EVLA was found to be more cost-effective with a shorter duration of procedure was shorter than RFA.…”

“…[16] Although the sample size was sufficient, the short follow-up period of 12 months was a limitation. Therefore, further long-term, large-scale studies are required to confirm these findings.…”

“…However, after RFA, the patients felt more comfortable and the required amount of tumescent anesthesia was lower. [16] Agus et al [17] reported a complete occlusion rate of 97% during three-year follow-up and found no major complications during the EVLA treatment, which was administered with 810 nm and 980 nm wavelength diode laser.…”

Development of a Minimum Data Set Registry for Chronic Venous Insufficiency of the Lower Limbs

“…With these 39 documents, we developed an MDS for the prevention, diagnosis, and treatment of CVI, with a total of 125 items grouped into seven categories, as follows:Patient examination [3,4,5,6,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55] (Table 1), with two sub-categories, as follows: Risk factors, with 15 items covering personal circumstances that increase the likelihood of CVD. These items include age, sex, and family history of CVI.Leg conditions, with 22 items related to the signs and symptoms of venous disease of the lower limbs such as cramps, heaviness, and varicose veins.Diagnostic studies [6,21,23,26,27,28,29,30,31,32,33,34,35,36,38,39,40,42,43,44,47,49,…”

Controlled Hypothermia of the Limb After Phlebectomy: Results of Comparative Study

“…В послеоперационном периоде у больных, перенесших флебэктомию, развиваются подкожные кровоизлияния, гематомы, формируется посттравматический отек нижней конечности и болевой синдром, связанные как с операционной травмой при извлечении варикозно-расширенных вен, так и с некоторым ограничением мобильности пациента в послеоперационном периоде [1][2][3][4]. Для предотвра-щения или снижения выраженности этих побочных явлений обычно используют эластичную компрессию.…”