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Online ISSN 1827-1847
Dietzek A. M.
Section of Vascular and Endovascular Surgery Linda and Stephen R Cohen Chair in Vascular Surgery Noninvasive Vascular Laboratory Danbury Hospital, Danbury, CT, USA
Chronic venous insufficiency (CVI) is the most common vascular disease and represents a significant health problem in both Europe and the United States. Symptoms of this disease include varicose veins, leg swelling, skin discoloration, and ulceration. Reflux of the great saphenous vein is the most common cause of CVI for which treatment has undergone great changes in the past decade. Prior to 1998, conventional treatment for symptomatic superficial vein reflux included saphenofemoral ligation, with stripping of the saphenous vein and removal of varicose veins when present. Recent advances in minimally invasive endovenous therapy have led to the development of catheter-based radiofrequency ablation (RFA) of the saphenous vein, which has become, arguably, the treatment of choice for symptomatic saphenous reflux. Since its market release in Europe in 1998, and subsequent release in the United States in 1999, almost 400 000 RFA procedures have been performed worldwide. Procedure safety and efficacy are well understood, with over 70 articles on the subject, most in peer review journals, and 10 book chapters published since 2000. Included are four randomized trials comparing this technology with traditional vein stripping and ligation, a comparative trial of RFA and laser ablation and five publications on data collected from a manufacturer (VNUS Medical Technologies, San Jose, CA, USA) sponsored registry which followed RFA patients for five years after treatment. With the introduction of tumescent anesthesia, the great majority of RFA procedures are now performed in an office setting. This article reviews the evolution of RFA in the treatment of saphenous reflux as well as data comparing it to saphenous vein stripping and laser ablation. Procedural techniques, mechanism of action and clinical outcomes using the closure catheter system are also discussed. Finally, closure FAST, a new generation RFA catheter which has demonstrated significant improvement in the ease of use and the procedure speed as compared to the earlier generation catheters, while maintaining the favorable patient recovery profile seen with RFA technology, is discussed.