The following question was posed on You Tube on our video of RFiTT ablation of Varicose Veins (
http://www.youtube.com/watch?v=fUQsaY1oY2M). As there is a limit to characters there, we have posted the full answer here:
Question:
What are the chances of developing DVT after closing the GSV with RFA procedure? What would be the best way to avoid developing DVT after RFA on the left GSV? Will there be a chance the the vein can reopen within a few weeks after the treatmenet?
Answer:
Thank you for your question.
If we look at all forms of deep vein thrombosis after all forms of radiofrequency ablation, over the last 12 years, then in our experience the risk is 0.7%, and this is in our published research which you can find via the link: http://www.ncbi.nlm.nih.gov/pubmed/20655773 (the full reference is at the bottom of this comment).
However that is a gross over-estimation compared to our current results under local anaesthetic using the RFiTT device. When we looked at our results in this publication, we were looking at mainly the VNUS Closure catheters, which we do not use more recommend any more, as we find big advantages with RFiTT radiofrequency ablation. For of 17 patients did not have a true DVT but only the minor EHIT. Of the others, the majority of them had other procedures performed including stripping of the small saphenous vein which we do not do any more as these can easily be closed with RFiTT, and also almost all of the DVT is would in patients who had general anaesthetic wear as nowadays we only perform local anaesthetic unless the patient insists.
It is well recognised that general anaesthetic is associated with a higher risk of deep vein thrombosis as the patient does not move so much and also you have to starve before a general anaesthetic, making you dehydrated are more likely to get a DVT. Since using RFiTT for our radiofrequency ablation some two years ago, and since performing all of our procedures under local anaesthetic since 2005, we have not had a major deep-vein thrombosis due to the radiofrequency ablation since. Therefore the risks are very low although of course it is possible that someone somewhere will get one, as people get DVT's occasionally even if they're not having any procedure!
With regards reducing the risks for your left GSV treatment:
- 1 - Have it done under Local Anaesthetic so you are not starved first and mobilising immediately
- 2 - Have sub cutaneous Heparin to cover the procedure (we give one dose during the procedure that lasts 24 hours)
- 3 - Make sure the technique used causes fibrosis of the vein wall - not thrombus formation in a semi-treated vein
Turning to your question about the risk of the vein opening up again a few weeks after treatment, this is virtually impossible provided the correct treatment is performed. When the first RFiTT device was produced, the recommendation was to use a very fast pullback which inadequately treated the vein. Reopening of the vein was very common after this, mainly due to the vein wall being inadequately treated and thrombus being formed inside the vein lumen. We contacted the company and spent some years explaining to them that their recommended treatments were suboptimal but for some while we were ignored. Fortunately Olympus then took over the RFiTT and we worked closely with them to optimise the treatment.
We started using RFiTT when we performed our own research and showed how to reduce the power and to reduce the pullback time. By doing this we make sure that the vein wall is maximally heated and the chance of reopening or thrombus formation is virtually zero.
This research won a prize in an international meeting in Milan a year ago and has been presented in the UK at a major vein meeting. Unfortunately not everybody uses our technique and so having RFiTT or any radiofrequency ablation really depends not only on having the optimal equipment but also ensuring that the person using it is experienced and is using the correct and optimal treatment settings.
We have recently audited our results and have 100% success at closing the GSV at one year.
We have submitted our research to Phlebology journal, but have met many obstacles in getting it published due to the peer review process. We sincerely hope that it will be published soon so that all doctors will be able to use our settings and will be able to give their patients the advantages that we can due to our research.
Reference:
Deep vein thrombosis (DVT) after venous thermoablation techniques: rates of endovenous heat-induced thrombosis (EHIT) and classical DVT after radiofrequency and endovenous laser ablation in a single centre. Eur J Vasc Endovasc Surg. 2010 Oct;40(4):521-7. Epub 2010 Jul 23.
Marsh P, Price BA , Holdstock J, Harrison C, Whiteley MS.)
