Radiofrequency ablation for treatment of varicose veins. State of the art 2014

Background. Radiofrequency ablation (RFA) was approved for treatment of superficial venous reflux in Germany in 1998. In 2007 the system was further developed to include segmental thermal ablation at 120 degrees C. The aim of this review is to summarize the current data on segmental thermal ablation regarding complications, results and quality of life (QoL). Methodology. For this review a selected search of the published literature on RFA was carried out in PubMed and an evaluation of patients treated with RFA since 1998 was performed. Results. The perioperative complication rate of RFA was low and comparable to open varicose vein surgery and endovenous laser therapy (ELT). Ecchymoses, hematomas, indurations, paresthesia and skin burns have been described in the perioperative period. In the European multicenter cohort study on Closure Fast (TM) it could be demonstrated that these side effects are permanent only in isolated cases. Deep venous thrombosis and/or pulmonary embolism did not occur in this European multicenter trial. The occlusion rates of treated veins were good and significantly better after segmental ablation at 120 degrees in comparison to continuous ablation at 85 degrees (Closure Plus (TM)). In the European multicenter study an occlusion rate of 91.7% could be observed after a follow-up of 5 years. The return to daily activities and work was significantly faster after RFA in comparison to open varicose vein surgery. A significant improvement in QoL and venous disorders could be observed in all studies which described these parameters. Discussion. The RFA is a minimally invasive procedure for treatment of superficial venous reflux. Perioperative complications and side effects are very low. The advantages of RFA are that less preoperative complaints occur in comparison to open varicose vein surgery. The long-term results show no inferiority to open varicose vein surgery. Therefore, the American Venous Forum has recommended that RFA is one of the first choices for treatment of superficial venous reflux in addition to ELT.