Radiofrequency ablation of varicose veins

Summary

Background: In the search of alternative techniques to high ligation and stripping (HL/S) in the treatment of varicose veins, catheter-ablation methods have been implemented since 1998. Besides endovenous laser techniques (ELT) radiofrequency ablation (RFA) is a successful device in treating insufficiency of the Great (GSV) and Small saphenous vein (SSV). Methods: This review article sums up publications on Closure Plus™, ClosureFAST™, RFITT^® (Celon Method), and EVRF^®. It discusses the actually favorized treatment protocols and study results. Results of meta-analysis are presented, too.

Results: The Closure Plus™ catheter was the first radiofrequency technique to be licensed in Europe in 1998. Trials and meta-analyzes show occlusion rates of 81–89 % after 5 years. The consecutive technique was the ClosureFAST™ (CLF) catheter that was introduced in 2007 and offered more standardization in treatment. Published data show occlusion rates of 98 % after 5 years and low profile on complications. Also in 2007 a bipolar radiofrequency technique called RFITT was presented. Due to lack of standards in treatment protocol it could not get accepted as well as CLF despite of good treatment results (92–98 % occlusion rates after 12 months) and low complications. A new RFA device called EVRF^® shows weak evidence so far.

Conclusion: Radiofrequency ablation of varicose veins has become a well-established treatment alternative to HL/S mostly represented by CLF.

Zusammenfassung

Hintergrund: Auf der Suche nach alternativen Techniken zur Behandlung der Stammvaricosis durch Crossektomie und Stripping wurden seit 1998 Katheterablationsmethoden eingeführt. Neben der endovenösen Lasertechnik (ELT) ist die Radiofrequenzablation (RFA) ein erfolgreiches Instrument in der Behandlung der Vena saphena magna und Vena saphena parva.

Methoden: Dieser Review fasst Publikationen zu Closure Plus^™, ClosureFast^™, RFITT^® und EVRF^® zusammen. Aktuell favorisierte Behandlungsprotokolle und Studienergebnisse werden vorgestellt. Ergebnisse von Metaanalysen werden ebenfalls berücksichtigt. Ergebnisse: Der Closure Plus^™-Katheter war die erste Radiowellentechnik, die 1998 in Europa zugelassen wurde. Studien und Meta-analysen zeigen Verschlussraten von 81–89 % nach 5 Jahren. Die folgende Technik war der ClosureFast^™-Katheter (CLF), der 2007 eingeführt wurde und eine bessere Standardisierung der Behandlung ermöglichte. Veröffentliche Daten zeigen Verschlussraten von 98 % nach 5 Jahren und ein geringes Nebenwirkungsprofil. Ebenfalls 2007 wurde die RFITT^® genannte bipolare Radiofrequenztechnik vorgestellt. Aufgrund mangelnder Standardisierung im Behandlungsprotokoll wurde dieses Verfahren nicht so gut angenommen wie CLF, obwohl gute Behandlungsergebnisse (92–98 % Verschlussrate nach 12 Monaten) bei geringen Komplikationen erreicht wurden. Ein neues RFA-Verfahren, das EVRF^® genannt wird, zeigt bislang eine schwache Datenlage.

Schlussfolgerung: Die Radiofrequenzablation der Stammvaricosis hat sich als Alternative zu Crossektomie und Stripping etabliert, wobei dies hauptsächlich durch CLF begründet wird.

Keywords

Varicose veins - radiofrequency ablation - ClosureFast™ - RFITT^®

Schlüsselwörter

Varicosis - Varikose - Radiofrequenzablation - ClosureFast™ - RFITT^®

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