CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 8, September 2013
AFRICA
313
Tumescentless endovenous radiofrequency ablation
with local hypothermia and compression technique
KEMAL KORKMAZ, ALİ ÜMİT YENER, HİKMET SELÇUK GEDİK, ALİ BARAN BUDAK, ÖZLEM YENER,
SERHAT BAHADIR GENÇ, AYŞE LAFÇI
Abstract
Introduction:
Modern surgical management of chronic
venous insufficiency is possible since the development of
catheter-based minimally invasive techniques, including
radiofrequency ablation (RFA) and the application of colour
Doppler sonography. RFA technology requires the use of
tumescent anaesthesia, which prolongs the operating time.
Instilling tumescent anaesthesia percutaneously below the
saphenous fascia is the steepest part of the learning curve. In
our study, we compared operative and postoperative results
of tumescentless RFA and RFA with tumescent anaesthesia,
to investigate the necessity of tumescent anaesthesia.
Methods:
A total of 344 patients with Doppler-confirmed
great saphenous vein insufficiency underwent RFA between
January and December 2012. Patients were divided into
two groups according to anaesthetic management. Group 1
consisted of 172 patients: tumescent anaesthesia was given
before the ablation procedure, and group 2 contained 172
patients: a local hypothermia and compression technique
was used; no tumescent anaesthesia was administered. The
visual analogue scale (VAS) was used and ecchymosis scores
of the patients were recorded. Clinical examinations were
performed at each visit and Doppler ultrasonography was
performed in the first and sixth month.
Results
: Mean ablation time was significantly lower in group
2 compared to group 1 (7.2 vs 18.9 min;
p
<
0.05). Skin burn
and paresthesia did not occur. The immediate occlusion rate
was 100% for both groups. No significant difference was
found between the groups in terms of VAS and ecchymosis
scores. All patients returned to normal activity within two
days. The primary closure rate of group 1 was 98.2% and
group 2 was 98.8% at six months, and there was no signifi-
cant difference between the groups (
p
>
0.05).
Conclusion:
Eliminating tumescent infusion is a desirable
goal. Tumescentless endovenous RFA with local hypother-
mia and compression technique appears to be safe and
efficacious. Our technique shortens the operation time and
prevents patient procedural discomfort.
Keywords:
radiofrequency ablation, tumescentless, insufficien-
cy of great saphenous vein
Submitted 1/6/13, accepted 13/8/13
Cardiovasc J Afr
2013;
24
: 313–317
DOI: 10.5830/CVJA-2013-053
Chronic venous insufficiency (CVI) is a frequent disease
affecting approximately 20 to 40% of people in Western society.
1
Generally, venous reflux at the great saphenous vein (GSV)
and/or saphenofemoral junction (SFJ) is the commonest cause,
leading to varicose veins and associated symptoms such as leg
pain, itching, fatigue, night cramps and a burning sensation.
2,3
In severe cases, swelling, skin changes and venous ulceration
may develop. CVI has also been related to thrombophlebitis and
pulmonary embolism.
4
The GSV ligation and stripping (L/S) operation was the
only treatment of choice from 1950 until recently.
5
However, it
is invasive, has a recurrence rate of approximately 30%, and is
not conservative.
3,6
Furthermore, Wood
et al
. reported the rate of
cutaneous nerve injury as 27% after L/S.
7
Modern surgical management of insufficiency of the GSV is
possible because of the development of catheter-based minimally
invasive techniques, including radiofrequency ablation (RFA)
and the application of colour Doppler sonography (CDS). RFA
is an alternative technique to L/S, working by ablating the vein
using thermal energy delivered through an RF catheter which
is inserted into the target vein under CDS guidence. It has
been recognised that RFA reduces postoperative recovery time,
postoperative pain, wound-related complications, and enables
earlier return to normal activities.
8-10
RFA technology requires the use of tumescent anaesthesia
before the delivery of thermal energy through the catheter.
Tumescent anaesthesia provides a heat sink to prevent the
radiation of thermal energy to the surrounding tissues and
increases contact between the RF catheter and the vein wall
by mechanically reducing the luminal diameter.
11,12
However,
it prolongs the operation time and can be a source of patient
procedural discomfort. Furthermore instilling tumescent
anaesthesia percutaneously below the saphenous fascia under
CDS guidance is the steepest part of the learning curve. In our
study, we compared the operative and postoperative results of
tumescentless RFA and RFA with tumescent anaesthesia to
investigate the necessity of tumescent anaesthesia.
Methods
Patients underwent a physical examination by a vascular
surgeon. All the treated patients were symptomatic. Symptoms
Department of Cardiovascular Surgery, Numune Research
and Training Hospital, Ankara, Turkey
KEMAL KORKMAZ, MD,
ALİ ÜMİT YENER, MD
HİKMET SELÇUK GEDİK, MD
ALİ BARAN BUDAK, MD
SERHAT BAHADIR GENÇ, MD
Department of Radiology, Ankara Yuksek Ihtisas Research
and Training Hospital, Ankara, Turkey
ÖZLEM YENER, MD
Department of Anaesthesiology, Numune Research and
Training Hospital, Ankara, Turkey
AYŞE LAFÇI, MD
