How Is Radiofrequency And Laser Varicose Vein Treatment Performed?

One example of the use of technology in the treatment of varicose veins is through radiofrequency and laser treatments, where in the former, radio waves and in the latter, laser light is used to generate heat to burn and dry out the diseased veins. Both of these methods are referred to as thermal ablation, meaning cancellation by heat. Correct patient selection and the right application method are crucial for procedures carried out through heat.

Just like in any treatment method, it can be beneficial in the right hands and harmful in the wrong hands. A scalpel (a surgical cutting instrument used in operations) becomes a healing tool in the hands of a surgeon but can turn into a injuring knife in the hands of an unskilled individual. Therefore, I would like to emphasize once again what we always repeat: it is essential to consult a cardiovascular surgeon specialized in this field for varicose vein treatment.

Radiofrequency and laser are used in two ways in the treatment of varicose veins. In the first method, for the treatment of large varicose veins, a catheter is sent into the vein, and a burning process is applied from inside the vein. In the second method, varicose veins at the capillary level are directly burned and dried on the skin.

1- ENDOVENOUS (INSIDE THE VEIN) RADIOFREQUENCY ABLATION (EVRF) and ENDOVENOUS LASER ABLATION (EVLA) IN VARICOSE VEIN TREATMENT

Ablation means elimination or cancellation. In the surgical method, varicose veins are surgically removed from the body through incisions, while in the EVRF and EVLA methods, the diseased and enlarged vein is canceled by burning in its place. The method used for this is thermal ablation, heating the vein with radio waves or laser light. The diseased vein canceled by heat is gradually absorbed by the body over time. Immediately after the procedure, the patient’s complaints related to venous leakage and blood pooling also disappear.

When using thermal ablation methods such as laser and radiofrequency, the most significant issue is to prevent the heat that burns the diseased vein from damaging other tissues. A method has been developed for this purpose. This method involves surrounding the diseased vein with a liquid, isolating it from other tissues, and then performing the burning process. This liquid is called tumescent anesthesia. It contains anesthetic substances, serum, and some tissue protectors. Besides isolating the diseased vein from surrounding tissues, it also has additional benefits, such as exerting pressure on the enlarged vein to reduce its diameter. This results in minimal clot formation inside the vein after the procedure, reducing the patient’s pain. It should be delivered accurately under ultrasound guidance to the area where the varicose vein is located.

For all endovenous procedures, which means procedures performed from inside the vein, another important point is that the performing physician must have the necessary ultrasound knowledge. Today, almost all cardiovascular surgeons have the Doppler ultrasound knowledge and experience they can use in such interventional methods. Since endovenous treatments have begun to replace surgery, training programs for cardiovascular surgical assistants have been expanded to include this topic and have reached competence with the support of congresses and experiences. In cases where necessary, support from radiologists may be sought for diagnostic purposes, but cardiovascular surgeons have sufficient knowledge and skills in treatment applications.

We categorize EVRF and EVLA as non-surgical treatments. These are methods that do not require anesthesia, do not involve incisions or stitches, and do not require hospitalization. After the procedure, the patient can immediately return to work and social life. There is no pain during the application. Sometimes, for the patient not to remember the procedure, they may prefer a light sedation (not general anesthesia) called sedation. Most of the time, local anesthesia is sufficient only for the needle insertion site.

We can use compression stockings for about fifteen days after the procedure. If the patient also has reticular (2-3 mm bluish veins) and spider veins, these are treated in another session following this procedure. Foam sclerotherapy or laser and radiofrequency methods on the skin are used for their treatment. As you can see, in the treatment of a patient, we can sometimes use a combination of several treatments. Therefore, the physician must have experience and the possibility of applying all these treatments.

2- THERMAL ABLATION THROUGH RADIOFREQUENCY OR LASER ON THE SKIN

It provides the most successful results for spider veins up to 1-2 mm. It is a bit more painful compared to other treatments but can be tolerated. I would like to emphasize that another alternative for veins at this level is microsclerotherapy, which is less painful.

For thermal burning procedures on the skin, it is beneficial to have previously treated larger veins (reticular). The patient should come for treatment without applying any cosmetic products to their leg, and until the redness that will occur after the treatment heals, these areas should not be exposed directly to sunlight.

There will be redness in the treated areas, followed by peeling, and these will improve within 2-4 weeks. If a second session is needed, there should be a 4-week interval.

HOW IS EVRF AND EVLA APPLIED? (TREATMENT OF LARGE VEINS WITH RADIOFREQUENCY AND LASER)

Before the treatment, the patient, whose vein map is drawn with Doppler ultrasound, is placed on the treatment table. The side or sides to be treated are cleaned with sterile liquid and surrounded by sterile drapes. By advancing a needle into the diseased vein, which is determined by ultrasound, a guide wire is sent through this needle, and a sheath or sleeve through which the catheter will advance is placed in the vein. All procedures are performed through a needle hole, and the area where the needle enters is anesthetized with local anesthesia to prevent the patient from feeling pain. Then, depending on the type of procedure to be performed, either the laser or radiofrequency catheter is advanced into the diseased vein through this sheath. The level inside the vein is determined by ultrasound and fixed. Subsequently, tumescent anesthesia solution is injected around the vein to isolate it, and its diameter is reduced. In this final stage, thermal ablation is applied to the varicose vein with radiofrequency or laser heat, and the catheter is removed from the vein, concluding the procedure. The patient is bandaged or given compression stockings and discharged for a follow-up appointment.

IS RADIOFREQUENCY OR LASER BETTER FOR VARICOSE VEIN TREATMENT?

Both methods use heat for treatment, with the only difference being the source of the heat. When looking at the results of the treatment, considering post-procedure pain and bruising, the risk of recurrence, and patient comfort, we see that both methods yield similar outcomes. The crucial factor here is not the choice between the two methods but rather the proper application of the chosen procedure with the right technique, and the experience of the physician you consult with.

WHAT ARE THE SIDE EFFECTS OF EVRF AND EVLA?

Although side effects are rare, it is worth mentioning:

• Nerve damage, skin damage, and deep vein thrombosis (DVT) due to thermal effects or deep vein trauma may occur.
• Allergic side effects to local anesthetic drugs may rarely occur.
• Multiple needle insertions during vein identification and tumescent administration and subsequent bruising and pain in the leg may occur.
• If tumescent is not administered correctly, the development of thrombophlebitis may occur, leading to prolonged pain and a feeling of tension for the patient after the procedure.
• Inadequate closure may occur.