Varicose vein treatment using the radiofrequency ablation method is a minimally invasive procedure. Patients thus benefit from less postoperative pain and a shorter recovery period. This technology, which destroys vein walls with high temperatures, has achieved a high success rate of approximately 99%. However, this method can lead to mild side effects such as superficial phlebitis and bruising. It offers fewer complications compared to traditional surgery and has therefore become a preferred method.
Prof. Dr. Özgür KILIÇKESMEZ
Interventional Radiology / Interventional Neuroradiology
How Does Radiofrequency Ablation (RFA) Work?
Radiofrequency ablation (RFA) stands out as an effective method in varicose vein treatment. The procedure consists of four main stages:
- Ultrasound Mapping and Local Anesthesia: The treatment begins with ultrasound mapping to clearly locate the vein. Once mapping is complete, local anesthesia is applied to the treatment area. This step ensures the patient’s comfort during the procedure.
- Catheter Placement: After anesthesia, a small incision is made in the affected area. A thin catheter is then advanced through the incision into the vein. This ultrasound-guided step ensures the catheter progresses correctly within the vein.
- Heating with Radiofrequency: Once the catheter reaches the target vein, radiofrequency energy heats the vein walls, causing them to contract and eventually close. During this process, ultrasound continuously monitors the catheter’s position and helps ensure proper heating.
- Vein Closure: After heating is complete, the catheter is slowly withdrawn. This allows the treated vein to close gradually.
- Post-Procedure Ultrasound Check: After catheter removal, a final ultrasound check confirms that the vein has been successfully closed and identifies any complications.
Who Is a Candidate for RFA Treatment?
Radiofrequency ablation may not be suitable for individuals with certain health conditions. People with active blood clots carry a higher risk of embolism during the procedure, which can prevent the treatment from being performed safely. Those with advanced arterial disease are also not ideal candidates, as their blood flow is already restricted and RFA could further jeopardize circulation.
Below are the conditions that make RFA unsuitable:
- Active deep vein thrombosis
- Pregnant women
- Severe peripheral arterial disease
- Infection or skin disorders in the treatment area
- Bedridden or non-ambulatory individuals
Temporary worsening of varicose veins during pregnancy can negatively affect RFA outcomes, so the procedure is generally not recommended for pregnant women. Similarly, infections or skin issues at the treatment site increase the risk of complications. For patients who are bedridden or have difficulty walking, RFA is unsuitable because ambulation plays a crucial role in postoperative recovery and in reducing potential complications.
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What Are the Advantages of RFA Compared to Other Treatments?
Radiofrequency ablation (RFA) offers significant advantages in varicose vein treatment, particularly rapid recovery times and a low risk of complications. Patients typically return to their normal activities within one or two days after the procedure, resulting in minimal interruption to work and social life. Reduced pain and bruising increase patient comfort and preference.
When compared with other treatments, RFA’s efficacy rates are noteworthy:
- Vein closure rates range from 95% to 98%, which can be higher than those of traditional surgical methods and endovenous laser treatment (EVLT).
- Shorter recovery times compared to traditional methods allow patients to resume daily life more quickly.
How Long Does the RFA Procedure Take and What Is the Recovery Process?
The radiofrequency ablation procedure is known for its effectiveness in varicose vein treatment. The total duration, including preparation and recovery, can range from one to three hours. The heating of the problematic vein via catheter usually takes 45 to 60 minutes. Patients undergo treatment under local anesthesia and, since the procedure is outpatient, can return home the same day.
Post-treatment care includes the following measures:
- Wearing compression stockings for one to two weeks to support circulation and speed up recovery.
- Encouraging walking during the first hours after the procedure to boost blood flow and reduce complication risks.
- Avoiding strenuous physical activities for several days to two weeks.
During the rest period, elevating the legs is recommended, especially for the first few days. Activities such as hot baths and heavy lifting should be avoided. Most patients can resume normal life within one to three days, although full recovery—including reduction of bruising and pain—typically takes two to three weeks.
What Are the Risks and Side Effects of RFA?
Radiofrequency treatment for varicose veins is notable among minimally invasive methods. Its side effects are usually mild and resolve quickly in most cases. Common mild side effects include:
- Bruising and swelling at the treated area.
- Numbness or tingling from temporary nerve irritation.
- Skin discoloration, such as hyperpigmentation.
- Less common but potentially serious complications:
- Infections at incision or injection sites, which may require treatment.
- Blood clots, especially if deep vein thrombosis precautions are not taken postoperatively.
- Pulmonary embolism, which occurs if blood clots travel to the lungs and requires urgent intervention.
Because radiofrequency ablation is less invasive than other surgical methods, overall complication rates are lower. However, as with any medical procedure, rare instances of nerve damage or vein recanalization can occur.
What Are the Success Rates of RFA?
Radiofrequency ablation (RFA) stands out in varicose vein treatment with remarkable success rates. Initial vein closure rates typically range from 93% to 98%, demonstrating highly effective short-term results. These outcomes clearly reflect the procedure’s efficacy within the first 12 months. Long-term data also support this effectiveness:
- Trunk vein closure rates exceed 80% within the first five years.
- Success rates reach approximately 93% between five and seven years.
These results indicate that RFA is a durable and powerful treatment option. Recurrence rates vary based on factors such as:
- Patient lifestyle,
- Existing venous insufficiencies,
- Vein diameter.
These factors generally contribute to a 20%–30% chance of recurrence within five years, usually due to new vein formation or recanalization. Nonetheless, these rates are lower compared to older surgical methods. Patient satisfaction is high, with reported satisfaction rates between 80% and 95% post-treatment.
Radiofrequency ablation (RFA) is a minimally invasive method for treating varicose veins. A thin, flexible catheter is inserted into the affected vein, and radiofrequency energy heats the vein walls to seal them shut, redirecting blood flow to healthy veins. This process alleviates symptoms associated with varicose veins.
Radiofrequency ablation (RFA) is highly effective for varicose veins, with a vein closure rate of approximately 95%. However, there is about a 7% recurrence rate, meaning veins may not disappear completely in all cases.
Recurrence after radiofrequency ablation (RFA) is around 7%, and the recanalization rate is approximately 3%. The overall success rate is estimated at 95%. The most common complications include bruising (13%), firmness (11.6%), edema (8%), ecchymosis (7.4%), and numbness (6.3%).
During radiofrequency ablation (RFA), patients usually experience mild discomfort, primarily when anesthetic is injected along the varicose vein. Studies report that over 80% of patients feel mild to moderate pain during local anesthesia, with male patients reporting slightly higher pain levels than females. Once the RFA procedure begins, most patients feel little to no pain. Post-procedure, some may experience temporary side effects such as bruising, swelling, or sensitivity, which typically resolve within weeks. Overall, RFA is considered a minimally invasive and well-tolerated varicose vein treatment.
Most individuals resume normal daily activities within one or two days after radiofrequency ablation (RFA). However, to optimize recovery, it is recommended to avoid heavy exercise and lifting for at least one week. Compression stockings should be worn for at least two weeks to support healing and reduce discomfort.
Prof. Dr. Özgür Kılıçkesmez graduated from Cerrahpaşa Medical Faculty in 1997. He completed his specialization at Istanbul Education and Research Hospital. He received training in interventional radiology and oncology in London. He founded the interventional radiology department at Istanbul Çam and Sakura City Hospital and became a professor in 2020. He holds many international awards and certificates, has over 150 scientific publications, and has been cited more than 1500 times. He is currently working at Medicana Ataköy Hospital.
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