The aim of this study was to assess the effectiveness of treating varicose veins under local anaesthetic using radiofrequency ablation in a modified outpatient setting. Prospective data was collected from an NHS local anaesthetic varicose vein unit, run by Ian Franklin, between April 2007 and May 2008. The study involved 159 patients (67 men and 92 women). The median age was 51 years (range 18–88), 48% of patients had CEAP 4a to 6, and 38 (30%) radiofrequency ablation procedures were for recurrent veins. Patients unsuitable for day surgery general anaesthesia due to comorbidities, eg obesity and severe ischaemic heart disease, were included.
During the time period, 225 procedures were performed, consisting of radiofrequency ablation (158) using VNUS ClosureFAST catheters, phlebectomy (55), foam sclerotherapy (seven) and perforator ablation (five) using VNUS ClosureRFS stylets. No sedation was used.
“Many of you will be confident with the technique of ClosureFAST. Some people use sedation, some do not. We use EMLA cream applied over the refluxing vein and go to great lengths to keep the patient comfortable, relaxing them with music. Hot cups of tea help keep them hydrated and allow their veins to dilate, making cannulation easier. There is no anaesthetist, no anaesthetic monitoring, and no sedation. Following the procedure the patient can mobilise with a class II compression stocking,” said Metcalfe.
Of the vessels treated with radiofrequency ablation, 126 were great saphenous veins, 14 were small saphenous veins and 18 were accessory thigh veins. According to Metcalfe, six (3%) procedures were abandoned due to difficult cannulation. An overall complication rate of 8% was observed, including neuropraxia (seven), skin pigmentation (four), bruising (three), pain (three) and phlebectomy site infection (two). There were no deep vein thromboses.
The results showed that most (74%) procedures enabled the patient to return to work within 24 hours of radiofrequency ablation and analgesic requirements were minimal, 67% of patients took no anaesthetic and only 16% required analgesia 24 hours following surgery. Follow-up duplex scans performed in 104 (65%) patients demonstrated complete occlusion in 94% and near-complete occluison in the remainder. Only 28 (18%) limbs required phlebectomies following radiofrequency ablation.
“Some patients were lost to follow-up and due to limited resources we stopped routine postoperative duplex imaging. Duplex demonstrated complete occlusion in 94%, the remainder having segmental occlusion, where a length of <3cm of reflux was seen,” said Metcalfe. “Local anaesthetic treatment of varicose veins offering different modalities of treatment is effective and well tolerated. Radiofrequency ablation of truncal veins produced a 94% occlusion rate with only 18% requiring subsequent phlebectomies,” Metcalfe told Vascular News.
