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Phlebologie 2017; 46(03): 137-142
DOI: 10.12687/phleb2373-3-2017
Review
Schattauer GmbH

Radiofrequency ablation of varicose veins

Radiofrequenztherapie der Varicosis
J. Tesmann
1   Hautzentrum Innenstadt, Stuttgart, Germany
› Author Affiliations
Further Information

Publication History

Received: 21 April 2017

Accepted: 24 April 2017

Publication Date:
04 January 2018 (online)

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Summary

Background: In the search of alternative techniques to high ligation and stripping (HL/S) in the treatment of varicose veins, catheter-ablation methods have been implemented since 1998. Besides endovenous laser techniques (ELT) radiofrequency ablation (RFA) is a successful device in treating insufficiency of the Great (GSV) and Small saphenous vein (SSV). Methods: This review article sums up publications on Closure Plus™, ClosureFAST™, RFITT® (Celon Method), and EVRF®. It discusses the actually favorized treatment protocols and study results. Results of meta-analysis are presented, too.

Results: The Closure Plus™ catheter was the first radiofrequency technique to be licensed in Europe in 1998. Trials and meta-analyzes show occlusion rates of 81–89 % after 5 years. The consecutive technique was the ClosureFAST™ (CLF) catheter that was introduced in 2007 and offered more standardization in treatment. Published data show occlusion rates of 98 % after 5 years and low profile on complications. Also in 2007 a bipolar radiofrequency technique called RFITT was presented. Due to lack of standards in treatment protocol it could not get accepted as well as CLF despite of good treatment results (92–98 % occlusion rates after 12 months) and low complications. A new RFA device called EVRF® shows weak evidence so far.

Conclusion: Radiofrequency ablation of varicose veins has become a well-established treatment alternative to HL/S mostly represented by CLF.

Zusammenfassung

Hintergrund: Auf der Suche nach alternativen Techniken zur Behandlung der Stammvaricosis durch Crossektomie und Stripping wurden seit 1998 Katheterablationsmethoden eingeführt. Neben der endovenösen Lasertechnik (ELT) ist die Radiofrequenzablation (RFA) ein erfolgreiches Instrument in der Behandlung der Vena saphena magna und Vena saphena parva.

Methoden: Dieser Review fasst Publikationen zu Closure Plus™, ClosureFast™, RFITT® und EVRF® zusammen. Aktuell favorisierte Behandlungsprotokolle und Studienergebnisse werden vorgestellt. Ergebnisse von Metaanalysen werden ebenfalls berücksichtigt. Ergebnisse: Der Closure Plus™-Katheter war die erste Radiowellentechnik, die 1998 in Europa zugelassen wurde. Studien und Meta-analysen zeigen Verschlussraten von 81–89 % nach 5 Jahren. Die folgende Technik war der ClosureFast™-Katheter (CLF), der 2007 eingeführt wurde und eine bessere Standardisierung der Behandlung ermöglichte. Veröffentliche Daten zeigen Verschlussraten von 98 % nach 5 Jahren und ein geringes Nebenwirkungsprofil. Ebenfalls 2007 wurde die RFITT® genannte bipolare Radiofrequenztechnik vorgestellt. Aufgrund mangelnder Standardisierung im Behandlungsprotokoll wurde dieses Verfahren nicht so gut angenommen wie CLF, obwohl gute Behandlungsergebnisse (92–98 % Verschlussrate nach 12 Monaten) bei geringen Komplikationen erreicht wurden. Ein neues RFA-Verfahren, das EVRF® genannt wird, zeigt bislang eine schwache Datenlage.

Schlussfolgerung: Die Radiofrequenzablation der Stammvaricosis hat sich als Alternative zu Crossektomie und Stripping etabliert, wobei dies hauptsächlich durch CLF begründet wird.

Keywords

Varicose veins - radiofrequency ablation - ClosureFast™ - RFITT®

Schlüsselwörter

Varicosis - Varikose - Radiofrequenzablation - ClosureFast™ - RFITT®
 

  • References

  • 1 Bradbury A. et al. What are the symptoms of varicose veins?. BMJ 1999; 318 7180 353-356.
    CrossrefPubMedSearch in Google Scholar
  • 2 Sarin S. et al. Stripping of the long saphenous vein in the treatment of primary varicose veins. Br J Surg 1994; 81: 1455-1458.
    CrossrefPubMedSearch in Google Scholar
  • 3 Allegra C, Antignani PL, Carlizza A. Recurrent varicose vein following surgical treatment. Eur J Vasc Surg 2007; 33: 751-756.
    Search in Google Scholar
  • 4 Fischer R, Linde N, Duff C. et al. Late recurrent saphenofemoral junction reflux after ligation and stripping of the greater saphenous vein. J Vasc Surg 2001; 34: 236-240.
    CrossrefPubMedSearch in Google Scholar
  • 5 van den Bos R. et al. Endovenous therapies of lower extremity varicosities: a meta-analysis. J Vasc Surg 2009; 49 (Suppl. 01) 230-239.
    CrossrefPubMedSearch in Google Scholar
  • 6 Eklöf B, Perrin M. Review of randomized controlled trials comparing endovenous thermal and chemical ablation. Rev Vasc Med 2014; 2 (Suppl. 01) 1-12.
    Search in Google Scholar
  • 7 Schmedt CG. et al. Investigation on radiofrequency and laser (980 nm) effects after endoluminal treatment of saphenous vein insuffiency in an exvivo model. Eur J Vasc Endovasc Surg 2006; 3: 318-325.
    Search in Google Scholar
  • 8 Mert D, Ibrahim U. Comparing cold and warm tumescent anesthesia for pain perception during and after the endovenous laser ablation procedure with 1470 nm diode laser. Phlebology 2015; 30 (Suppl. 01) 45-51.
    CrossrefPubMedSearch in Google Scholar
  • 9 Goode SD, Kuhan G, Altaf N. et al. Suitability of varicose veins for endovenous treatments. Cardiovasc Intervent Radiol 2009; 32: 988-991.
    CrossrefPubMedSearch in Google Scholar
  • 10 Nesbitt C, Eifell RK, Coyne P. et al. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices. Cochrane Database Syst Rev 2011; Oct 5 10: CD005624.
    Search in Google Scholar
  • 11 Covidien (UK) Commercial Ltd.. Instructions for use: ClosureFast catheter (package insert). Hampshire, UK: 2014
    Search in Google Scholar
  • 12 Bakker NA, Schieven LW, Bruins RMG. et al. Compression Stockings after Endovenous Laser Ablation of the Great Saphenous Vein: A Prospective Randomized Controlled Trial. Eur J Vasc Endovasc Surg 2013; Nov 46 (Suppl. 05) 588-592.
    CrossrefPubMedSearch in Google Scholar
  • 13 Nijsten T, van den Bos RR, Goldman MP, Kockaert MA, Proebstle TM, Rabe E. et al. Minimally invasive techniques in the treatment of saphenous varicose veins. J Am Acad Dermatol 2009; 60 (Suppl. 01) 110-119.
    CrossrefPubMedSearch in Google Scholar
  • 14 Schmedt CG, Steckmeier BM. Endoluminale Radiofrequenz- und Lasertherapie zur Therapie der Stammveneninsuffizienz. In: Marshall, Breu (Hrsg). Handbuch der Angiologie. 2006: 15. Erg.-Lfg. 12; 3–12.
    Search in Google Scholar
  • 15 Noppeney T, Noppeney J, Winkler M. Update der Ergebnisse nach Radiofrequenzobliteration zur Ausschaltung der Varikose. Gefäßchirurgie 2008; 13: 258-264.
    CrossrefSearch in Google Scholar
  • 16 Luebcke T, Brunkwall J. Systematic review and metaanalysis of endovenous radiofrequency obliteration, endovenous laser therapy and foam sclerotherapy for primary varicosis. J Cardiovasc Surg 2008; 49: 213-233.
    Search in Google Scholar
  • 17 van den Bos R, Arends L, Kockaert M, Neumann M, Nijsten N. Endovenous therapies of lower extremity varicosities: a metaanalysis. J Vasc Surg 2009; 49: 230-239.
    CrossrefPubMedSearch in Google Scholar
  • 18 Proebstle TM, Vago B, Alm J, Göckeritz O, Lebard C, Pichot O. Treatment of the incompetent great saphenous vein by endovenous radiofrequency powered segmental thermal ablation: first clinical experience. J Vasc Surg 2008; 47: 151-156.
    CrossrefPubMedSearch in Google Scholar
  • 19 Nordon IM, Hinchcliffe RJ, Brar R. et al. A prospective double-blind randomized controlled trial of radiofrequency versus laser treatment of the great saphenous vein in patients with varicose veins. Ann Surg 2011; 254: 876-881.
    CrossrefPubMedSearch in Google Scholar
  • 20 Proebstle TM, Alm J, Göckeritz O. et al. Three-year European follow-up of endovenous radiofrequency-powered segmental thermal ablation of the great saphenous vein with or without treatment of calf varicosities. J Vasc Surg 2011; 54: 146-152.
    CrossrefPubMedSearch in Google Scholar
  • 21 Bisang U, Meier TO, Enzler M. et al. Results of endovenous ClosureFast treatment for varicose veins in an outpatient setting. Phlebology 2012; 27: 118-123.
    CrossrefPubMedSearch in Google Scholar
  • 22 Shepherd AC, Gohel MS, Brown LC, Metcalfe MJ, Hamish M, Davies AH. Randomized clinical trial of VNUS® ClosureFAST™ radiofrequency ablation versus laser for varicose veins. Br J Surg 2010; 97: 810-818.
    CrossrefPubMedSearch in Google Scholar
  • 23 Calcagno D, Rossi JA, and Ha C. Effect of saphenous vein diameter on closure rate with ClosureFast radiofrequency catheter. Vasc Endovasc Surg 2009; 43: 567-570.
    CrossrefPubMedSearch in Google Scholar
  • 24 García-Madrid C, Pastor Manrique JO, Sánchez VA, Sala-Planell E. Endovenous radiofrequency ablation (Venefit Procedure): impact of different energy rates on great saphenous vein shrinkage. Ann Vasc Surg 2013; 27: 314-321.
    CrossrefPubMedSearch in Google Scholar
  • 25 Proebstle TM, Alm BJ, Göckeritz O. et al. Five-year results from the prospective European multicentre cohort study on radiofrequency segmental thermal ablation for incompetent great saphenous veins. Br J Surg 2015; 102 (Suppl. 03) 212-218.
    CrossrefPubMedSearch in Google Scholar
  • 26 Siribumrungwong B, Noorit P, Wilasrusmee C. et al. A systemic review and meta-analysis of randomized controlled trials comparing endovenous ablation and surgical intervention in patients with varicose vein. Eur J Vas Endovasc Surg 2012; 44: 214-223.
    CrossrefPubMedSearch in Google Scholar
  • 27 Almeida JI, Kaufman J, Göckeritz O. et al. Radio-frequency endovenous ClosureFAST versus laser ablation for the treatment of great saphenous re-flux: a multicenter, single-blinded, randomized study (RECOVERY study). J Vasc Interv Radiol 2009; 20: 752-759.
    CrossrefPubMedSearch in Google Scholar
  • 28 Lewis BD. RE: Radiofrequency endovenous Closure Fast versus laser ablation for the treatment of great saphenous reflux – a multicenter, single-blinded, randomized study (RECOVERY study). J Vasc Interv Radiol 2010; 21: 302. author reply 302–303.
    PubMedSearch in Google Scholar
  • 29 Camci M, Harnoss B, Akkersdijk D. et al. Effectiveness and tolerability of bipolar radiofrequency-induced thermotherapy for the treatment of incompetent saphenous veins. Phlebologie 2009; 38: 5-11.
    Thieme ConnectSearch in Google Scholar
  • 30 Reich-Schupke S, Mumme A, and Stücker M. Histopathological findings in varicose veins following bipolar radiofrequency induced thermotherapy – results of an ex vivo experiment. Phlebology 2011; 26: 69-74.
    CrossrefPubMedSearch in Google Scholar
  • 31 Olympus & Wibe GmbH.. Instructions for use: CelonProCurve catheter. (package insert). Hamburg, Germany: 2014
    PubMedSearch in Google Scholar
  • 32 Tesmann JP, Thierbach H, Dietrich A. et al. Radio-frequncy induced thermotherapy (RFITT) of varicose veins compared to endovenous laser treatment (EVLT): a non-randomized prospective study concentrating on occlusion rates, side-effects and clinical outcome. Eur J Dermatol 2011; 21 (Suppl. 06) 945-951.
    PubMedSearch in Google Scholar
  • 33 Braithwaite B, Hnatek L, Zierau U. et al. Radiofrequency-induced thermal therapy: Results of a European multicenter study of resistive ablation of incompetent truncal varicose veins. Phlebology 2013; 28: 38-46.
    CrossrefPubMedSearch in Google Scholar
  • 34 Newman JE, Meecham L, Walker RJ. et al. Optimising treatment parameters for Radiofrequency-induced thermal therapy (RFITT): A comparison of the manufacturer´s treatment guidance with a locally developed treatment protocol. Eur J Vasc Endovasc Surg 2014; 47: 664-669.
    CrossrefPubMedSearch in Google Scholar
  • 35 Boon R, Akkersdijk GL, and Nio D. Percutaneus treatment of varicose veins with bipolar radiofrequency ablation. Eur J Radiol 2010; 75: 43-47.
    CrossrefPubMedSearch in Google Scholar
  • 36 Goode SD, Chowdhury A, Crockett M. et al. Laser and radiofrequency ablation study (LARA study): A randomized study comparing radiofrequency ablation and endovenous laser ablation (810nm). Eur J Vasc Endovasc Surg 2010; 40: 246-253.
    CrossrefPubMedSearch in Google Scholar
  • 37 Spiliopoulos S, Theodosiadou V, Sotiriadi A. et al. Endovenous ablation of incompetent truncal veins and their perforators with a new radiofrequency system. Mid-term outcomes. Vascular 2015; 23 (Suppl. 06) 592-598.
    CrossrefPubMedSearch in Google Scholar
  • 38 FCare Systems.. Instructions for use: CR45i EVRF catheter (package insert). Antwerp, Belgium: 2014
    PubMedSearch in Google Scholar