Non-surgical treatment of leg varices and venous insufficiency (Endovenous RF Ablation (EVRA))

What are leg varices and venous insufficiency?

Leg varices, also known as varicose veins, are enlarged, swollen veins that often appear blue or purple in color and can be seen just beneath the surface of the skin. Venous insufficiency is a condition in which the veins in the legs are unable to efficiently return blood to the heart, leading to symptoms such as swelling, pain, and fatigue.

What causes leg varices and venous insufficiency?

The underlying cause of leg varices and venous insufficiency is often malfunctioning valves in the veins that prevent blood from flowing properly. This can lead to the blood pooling in the veins and causing them to become enlarged and swollen. Other risk factors can include age, obesity, pregnancy, genetics, and a history of blood clots.

What are the symptoms of leg varices and venous insufficiency?

Symptoms of leg varices can include visible swelling and bulging veins, aching or throbbing pain, itching or burning sensations, and a heavy or tired feeling in the legs. In more severe cases, the skin around the affected veins may become discolored or ulcerated. Symptoms of venous insufficiency can include swelling, pain, and a sensation of heaviness or fatigue in the legs.

How are leg varices and venous insufficiency diagnosed?

Diagnosis of leg varices and venous insufficiency typically involves a physical exam and a review of symptoms, as well as imaging tests such as a duplex ultrasound, which uses sound waves to create images of the veins and measure blood flow.

Why should leg varicose veins and venous insufficiency be treated?

Leg varicose veins and venous insufficiency are medical conditions that need to be treated. Here are the reasons:

Pain and discomfort: Leg varicose veins may be accompanied by discomfort such as pain, heaviness, itching, burning sensation and cramping. These symptoms can make you uncomfortable doing your daily activities and reduce your quality of life.

Skin wounds: Advanced leg varicose veins can cause skin sores. These wounds can be difficult and take a long time to heal. If left untreated, skin sores can grow larger and increase the risk of infection.

Blood clots: Leg varicose veins can increase the risk of blood clots called deep vein thrombosis. This condition can be fatal.

Cosmetic concerns: Leg varicose veins can limit your clothing options and cause cosmetic discomfort, especially in hot weather.

Venous insufficiency: Leg varicose veins are associated with venous insufficiency. This can cause swelling and pain in the legs due to poor circulation. If left untreated, venous insufficiency can worsen and permanent damage to the legs can occur.

For these reasons, leg varicose veins and venous insufficiency should be treated.

What are the treatment options for venous insufficiency and leg varicose veins?

There are many options for the treatment of venous insufficiency and leg varicose veins. In order for the treatment to be carried out correctly, it is necessary to be examined by a doctor first. You can choose between the following treatment options:

Medication: Some medications can be used for venous insufficiency and leg varicose veins. These drugs can help reduce varicose veins and edema and prevent blood from clotting. However, drug therapy is only used to relieve symptoms and does not completely cure varicose veins.

Compression stockings: Compression stockings are used in the treatment of leg varicose veins and venous insufficiency. By increasing the pressure in the legs, it increases blood circulation and reduces edema.

Sclerotherapy: Sclerotherapy is used in the treatment of small varicose veins. Using a needle, a special substance is injected into the varicose vein. This substance adheres to the inner surfaces of the vein and ensures the closure of the vein. This treatment is painless and quick and can usually be done in conjunction with walking.

Endovenous glue injection: In this method, a special glue (glue) is injected into the varicose vein. This adhesive adheres to the inner surfaces of the vein and ensures that the vein is closed. The possibility of lumps in the skin and subcutaneous tissue and the possibility of clotting in the lungs are among its complications.

Endovenous steam therapy: In this method, steam is injected into the varicose vein using a special device. This steam causes damage to the inner surfaces of the varicose vein and allows the vein to be closed. It needs more detailed studies.

Endovenous laser therapy: This treatment is used to treat varicose veins in the legs. Laser beams are directed into the varicose vein and provide closure of the vein. This treatment does not require surgical intervention and is usually painless.

Endovenous radiofrequency ablation: This method is used to treat varicose veins in the great saphenous vein or other great veins. In this process, the inner surfaces of the varicose vein are damaged by using radiofrequency energy and the vein is closed. Blood flow is diverted to normal veins. This procedure is usually performed under local anesthesia and the patient can return home the same day.

Surgical intervention: Surgical intervention is used to remove large varicose veins on the legs. This procedure is performed under general anesthesia and the patient can usually return home the same day.

Treatment options are determined by the patient's symptoms, the size and condition of the varicose veins. Therefore, it is important to consult a doctor to determine the correct course of treatment. Traditionally, surgical ligation and removal of these varices was the treatment of choice until recently. However, the treatment of these varicose enlargements as thermoablative (shrinking and occlusion due to heat) with interventional radiological imaging methods constitutes a current alternative. Thermoablative treatment of varicose veins by endovascular method; compared to surgery; today, it is the first preferred treatment method because it takes a shorter time, improves symptoms faster, has a faster recovery process, requires less hospitalization, is less painful, does not leave scars and scar tissue on the skin, and has high success and low recurrence rates. Microphlebectomy (removal of enlarged veins through a small opening) and application of sclerosing agents to spider veins are other methods applied in addition to thermoablative therapy.

What are the advantages and disadvantages of endovenous radiofrequency ablation (RFA) compared to other methods?

Endovenous radiofrequency ablation (RFA) is a widely used method in the treatment of leg varicose veins. In this method, high-frequency radio waves are sent into the varicose vein using a special device. These waves create heat on the inner surfaces of the vein and allow the vein to be closed.

Endovenous radiofrequency ablation has many advantages over other endovenous methods:

Less painful: This method is usually performed under local anesthesia and is less painful.

Less invasive: The RFA procedure is less invasive and requires a shorter recovery time compared to open surgery.

Higher success rate: The RFA procedure has a higher success rate compared to other methods such as sclerotherapy.

However, endovenous radiofrequency ablation also has some disadvantages:

Cost: This method has a higher cost compared to other methods.

High technology requirement: The RFA procedure requires specialized equipment and high technology, so it may not be available in every healthcare facility.

Risk of complications: As with any surgical procedure, endovenous radiofrequency ablation carries some risks of complications. These can include infection, bleeding, and vessel damage.

Nevertheless, endovenous radiofrequency ablation is a widely used and effective method for the treatment of leg varicose veins. Many clinical studies have shown that the success rate of the RFA procedure is high and patient satisfaction is also high.

What is endovenous radiofrequency ablation (RFA) and how does it work?

Endovenous radiofrequency ablation (RFA) is a minimally invasive procedure that uses heat generated by radiofrequency energy to treat varicose veins and venous insufficiency. The procedure involves the insertion of a thin catheter into the affected vein, which is then heated using radiofrequency energy. The heat causes the vein to collapse and seal shut, allowing blood to flow through nearby healthy veins instead.

How long does the RFA procedure take?

The RFA procedure typically takes between 30-60 minutes to complete, depending on the size and location of the affected vein.

Is the RFA procedure painful?

Most patients experience little to no pain during the RFA procedure. Local anesthesia is used to numb the area around the affected vein, and some patients may feel a mild sensation of heat during the procedure. After the procedure, patients may experience some mild discomfort or bruising at the site of the catheter insertion, but this can usually be managed with over-the-counter pain medication.

Endovenous radiofrequency ablation (RFA), how is it done?

After the patient is positioned appropriately and sterilization is achieved, first of all, a local anesthetic substance mixed with liquid is injected around the vessel along the vessel tracing called tumescent anesthesia or a femoral nerve blockade is applied. The reason for these applications is to minimize the patient's sense of pain. Then, usually by entering the superficial vein on the inside of the leg, starting from 1-1.5 cm below the junction of the superficial and deep veins and as far as possible, the superficial vein is inserted with thermoablative methods (such as laser, radiofrequency ablation, steam, etc.) with the help of a thin catheter. is shrunk. If there is insufficiency in the perforating veins, the same procedure is applied to these veins. If necessary, the enlarged veins in the leg are removed with a thin incision (microphlebectomy). For spider-like enlargements, injection of sclerosing substance is applied.

What is the recovery time after RFA?

Most patients are able to return to their normal activities within a day or two after the RFA procedure. However, strenuous exercise and heavy lifting should be avoided for at least a week after the procedure, and patients are usually advised to wear compression stockings for several days to help minimize swelling and promote healing.

How long does it take to recover from endovenous radiofrequency ablation?

Most patients can resume normal activities within a day or two after the procedure. However, patients may be advised to avoid strenuous activity and heavy lifting for several days to a week after the procedure. Compression stockings may need to be worn for a period of time after the procedure to promote healing and prevent blood clots.

Is endovenous radiofrequency ablation (RFA) a safe and effective treatment?

Endovenous radiofrequency ablation (RFA) is a widely used method for the treatment of chronic venous insufficiency. In this method, using a catheter, radiofrequency energy is applied to the targeted area on the inner surface of the vessel and the tissues in this area are destroyed by heating. This causes the vein to be blocked and the blood flow to be directed to healthy veins.

RFA is a safe and effective treatment modality in many studies. In many studies, it has been shown that symptoms decrease, patients' quality of life increases and long-term results of treatment are positive after RFA treatment. However, as with any medical procedure, RFA treatment has potential risks. These risks include infection, bleeding, vascular injury and anesthesia risks.

Therefore, as before any medical procedure, the patient should be evaluated in detail and the risks and benefits of treatment should be discussed before RFA therapy. In addition, it is important that the center where RFA treatment will be carried out is managed by experienced and qualified health professionals.

What are the risks and complications of the endovenous radiofrequency ablation (RFA) procedure?

1- Bruises, blood collections (ecchymoses) that can last up to 2 weeks throughout the treated area

2- A short-term feeling of tension and contraction in the treated leg after about a week

3- Superficial vascular inflammation

4- Nerve injuries

5- Clot formation in the leg

6- Skin burns

7- Complications related to the materials used in the method, such as fracture, inability to move.

Will I need to have multiple RFA treatments?

In most cases, only one RFA treatment is needed to achieve the desired results. However, in some cases, additional treatments may be necessary to fully treat all affected veins. Your doctor will be able to provide you with more information about what to expect based on your individual case.

What is the success rate of endovenous radiofrequency ablation for treating leg varices and venous insufficiency?

Studies have shown that endovenous RFA is highly effective, with success rates ranging from 85-98%. The success rate may depend on factors such as the size and location of the varicose veins, the severity of the venous insufficiency, and the experience of the physician performing the procedure.

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