Radiofrequency Ablation

• Excellent alternative to saphenous vein stripping surgery.
• Performed under local anaesthesia.
• Minimal to no discomfort.
• No admission to hospital or general anaesthesia.
• Minimal time off work or interference with normal home duties.
• Both legs can be treated in the one session.
• Surface varicosities are treated at the same time with Ultrasound Guided Sclerotherapy.

• Do not cease medications prior to treatment unless otherwise advised.
• Do not shave your legs immediately prior to your treatment.
• Do not apply moisturiser on the day of treatment.
• Wear slacks or loose trousers to the appointment and ensure you have a pair of comfortable walking shoes.
• Pre-medication is generally not necessary. If you have a low pain threshold, take 2 paracetamol tablets or 2 Ibuprofen tablets (with food).

• A sonographer or doctor will mark out the vein(s) to be lasered.
• A localised nerve block will be performed to anaesthetise the area of the leg to be treated.
• You will lie comfortably on the examination couch with your leg externally rotated if treating the great saphenous vein.
• If treating the small saphenous vein, you will be asked to lie prone.
• A small catheter is introduced through a small needle, into the disease vein.
• The RF Fibre is then passed through the catheter and into the vein and strategically positioned with Ultrasound Guidance, so that the 7 cm RF Tip is just below the top end of the vein. The RF fibre is connected to a RF Machine.
  Local anaesthetic known as “Tumescent Anaesthetic” is infiltrated around the vein with Ultrasound Guidance, at several levels through the anaesthetized skin.
  The RF Fibre is then activated for 20 seconds. A 7 cm length of vein will be heated to 120oC. The Temperature of the vein is monitored and kept at a consistent level to ensure that the vein is heated gently. The RF Fibre is then withdrawn 7 cm and the process is repeated for the entire length of the vein.
• The procedure is completely painless.

• Class 2 compression stockings will be applied by our nurse.
• Our nurse will discuss all the important post treatment instructions in great detail and provide you with a post instruction sheet.
• You will be directed to go for an immediate 20-30 minute walk before you drive home. As long as you are able to walk unaided without restriction, you are allowed to drive home.
• You will be given Dr Paraskevas’ after hours number should you have any problems or concerns.
• The stockings will be worn overnight for the first night.
• Following this, the stockings should be worn for a minimum of 14 days but only during the day. They can be removed for showering or when going to sleep at night.
• Walking for 30 minutes each day is mandatory.
• Maintain normal daytime activities but avoid standing still for long periods of time.
• Continue with normal exercise activities.
• You will be asked to avoid long haul flights (>4 hours of continuous travel) for at least 3-4 weeks after the treatment. If travel is unavoidable, then you will be protected from Deep Vein Thrombosis with Subcutaneous Low Molecular Weight Heparin (aka Clexane) during your travel.
• An ultrasound check of the lasered veins will occur 2 weeks after the treatment. This is to assess the outcome of the treatment and also to exclude the very low chance of deep vein occlusion.

The following features are expected. They are not a cause for concern although they should be reported at review:

• Mild to moderate pain persists for 1-2 weeks along the lasered vein. Post RFA discomfort should be managed with a combination of light walking and rest (with leg elevation), anti-inflammatory medication such as Nurofen or Voltaren and stocking wear.
• Phlebitis or inflammation may occur along the inner thigh in line with the lasered vein. This is again managed with anti-inflammatories and stockings. Dr Paraskevas must be contacted if this occurs.

Complications can occur even with perfect technique.

• Deep vein thrombosis. Internal Vein clots are extremely rare following RFA. Pulmonary Embolus, although reported in the literature, is also very rare.
• Nerve damage. Damage to surface sensory nerves can occur but this usually returns to normal within weeks to months. Persisting numbness is more common after surgical stripping of the saphenous vein below the knee. It is possible to inadvertently damage the Saphenous Nerve during below knee RFA. Damage can rarely occur to nerves behind the knee causing motor damage.
• Skin burns have been reported but have never been encountered in our practice.