Veins: Radio Frequency Ablation of LSV (VNUS Closure)
There are 2 main veins in the legs which function to bring blood from the legs back to the heart:
- Superficial venous system comprises of veins that are close to the skin surface.
- Deep venous system is the set of veins in the muscles of the legs.
Valves within the veins prevent the blood from flowing back down the leg, or refluxing. The refluxing veins cause build up of pressure within the veins causing the veins to become distended and swollen.
This procedure is done for patients with varicose veins and chronic venous hypertension who have reflux in the superficial veins.
A Radiofrequency catheter is passed up the Long Saphenous Vein (LSV). The RF energy is converted to heat energy at the end of the probe and causes inflammation of the LSV. This leads to eventual shrinkage and sclerosis of the LSV over time. Once the LSV is closed off, there will no longer be any more reflux in the veins.
This procedure is usually performed under Local Anaesthesia with monitored sedation. The anaesthetist will administer medication intravenously to keep the patient sedated and asleep during the procedure.
A General Anaesthetic may be considered if the patient is not suitable for monitored sedation or if the patient requests for a GA.
- The Long Saphenous Vein in the inner thigh is localised with an ultrasound scanner.
- A local anaesthetic injection is given and a sheath is placed inside the LSV.
- The radiofrequency catheter is then introduced into the sheath and passed up to the Sapheno-Femoral Junction (SFJ) at the groin.
- A solution of saline and local anaesthetic will be injected around the LSV under ultrasound guidance. This helps to reduce the incidence of skin burns.
- The radiofrequency catheter is then energised and this causes the last 7cm of the catheter to heat up to 1200C. This causes damage to the inner lining of the vein and the inflammation that is triggered in the LSV will cause it to eventually shrink and close off.
The prominent varicosities in the lower thigh and calf are then surgically removed through small incisions measuring about 3-5mm. These small wounds are then closed with special Steri-strip dressings. No sutures are required.
After the procedure, the leg will be bandaged with crepe bandage.
This surgery is usually performed as a Day Surgery, which means the patient does not need to be admitted overnight after the surgery.
The bandages can be removed after 24 hours and changed for post-op stockings that will need to be worn for 2 weeks. The stockings will prevent leg swelling and reduce the risk of bruising after the surgery.
During this period, the patient is encouraged to walk around to avoid Deep Vein Thrombosis (DVT). Generally, the patient will be advised to walk around at home only for the first 1-2 weeks. Excessive physical activity may lead to increased bruising along the medial thigh. After 2 weeks, patients can gradually increase their activity level back to normal.
For the first 6 to 8 weeks after the procedure, the patient may feel a hardened cord-like vein along the inner thigh, especially in the lower half where the LSV is closer to the skin.
The common complications associated with this procedure include:
- Bruising especially along the inner thigh
- Palpable cord-like Long Saphenous Vein along the inner thigh
- Skin burn from heat transmission to the skin
- Saphenous nerve injury, leading to patchy numbness along the lower inner thigh
- Bleeding and haematoma (clot) formation at the stab wounds
- Wound infection
- Recurrence of varicose veins, approximately 3-5% in 5 years
- Deep Vein Thrombosis (DVT)
The traditional approach to treating Long Saphenous Vein (LSV) incompetence is High Ligation of the Sapheno-Femoral Junction and stripping of the LSV. This is done via two incisions, one in the groin and another in the lower thigh. This is usually done under a General Anaesthetic. Post-operative pain scores are usually higher after surgery, compared to minimally invasive treatments such as Radiofrequency Ablation and EndoVenous Laser Therapy (EVLT).
An alternative minimally invasive approach to treating LSV incompetence is EndoVenous Laser Therapy (EVLT).