Varicose veins (VV) are tortuous, twisted, or elongated veins. This can be due to existing (inherited) valve dysfunction or decreased vein elasticity (primary venous reflux) or valve damage from prior thrombotic events (secondary venous reflux). The end result is pooling of blood in the veins, increased venous pressure and subsequent vein enlargement. As a result of high venous pressure, branch vessels balloon out leading to varicosities (varicose veins).
Symptoms typically affect the lower extremities and include (but are not limited to): aching, swelling, throbbing, night cramps, restless legs, leg fatigue, itching and burning. Left untreated, venous reflux tends to be progressive, often leading to chronic venous insufficiency (CVI).
CVI often results in chronic skin changes referred to as stasis dermatitis. Stasis dermatitis is comprised of a spectrum of cutaneous abnormalities including edema, hyperpigmentation, eczema, lipodermatosclerosis and stasis ulceration. Ulceration represents the disease end point for severe CVI. CVI is associated with a reduced quality of life particularly in relation to pain, physical function and mobility. In severe cases, VV with ulcers, QOL has been rated to be as bad or worse as other chronic diseases such as back pain and arthritis.
There are several treatment modalities like surgical ligation, stripping, sclerotherapy and endovenous thermal ablation.
Varicose vein radiofrequency treatment, uses radiofrequency to cauterize and close varicose veins in the legs. RFA works by destroying or ablating the refluxing vein segment using thermal energy delivered through a radiofrequency catheter. It may be used for cosmetic purposes, but it is most commonly used to help alleviate related symptoms such as aching, swelling, skin irritation, discoloration or inflammation. Endovenous ablation is safe, less invasive than conventional surgery, and leaves virtually no scars.
Endovenous ablation has replaced stripping and ligation as the technique for elimination of saphenous vein reflux.
Endovenous procedures are far less invasive than surgery and have lower complication rates. The procedure is well tolerated by patients, and it produces very good cosmetic results.
Ontario Health Technology Assessment Series 2011; Vol. 11, No.1