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RFiTT stands for Radiofrequency Induced Thermotherapy. It is also known as the Celon method of treating varicose veins after the subsidiary of Olympus that manufactures the device. The Celon method is another minimally invasive procedure for the treatment of varicose veins offered at the Manchester Vein Centre. It is ideal for treating refluxing/incompetent saphenous veins. It may also be used to treat incompetent perforators. During this procedure leaky veins are gently heated to temperatures of 60 ° to 85 °C using an ultra-thin tube that is inserted into the vein. This localized and precisely delivered application of radiofrequency energy causes the vein to shrink, close and gradually disappear.

With the RFiTT system we are able to treat our patients in an outpatient setting under local anaesthesia. This system uses radiofrequency ablation to gently, effectively and safely closes the abnormal veins that are giving rise to unsightly and/or uncomfortable varicosities. As it uses lower temperatures than other thermo-ablative techniques (minimally invasive procedures that use heat to close/seal the vein) thermal injuries and burns are avoided.

The RFiTT system results in significantly lower levels of post-operative discomfort or complications in comparison to conventional vein stripping and as it is able to close the vein using much lower temperatures than other techniques, it may also be better than other thermo-ablative techniques when it comes to recovery. All of the above advantages of RFiTT lead to rapid patient mobilization. Patients can walk immediately after the procedure takes place and can resume normal activities within a few days.

VNUS Closure

The VNUS Closure procedure is one of a number of minimally invasive treatments offered at the Manchester Vein Centre. Like all the minimally invasive treatments offered at our centre, it results in less pain and less bruising when compared to traditional vein stripping. It also compares better to laser treatment when it comes to post-operative recovery. Using the Closure system, the surgeon closes the diseased veins by inserting the Closure catheter into a vein and heating the vein wall using temperature-controlled Radiofrequency energy. Heating the vein wall causes its wall to shrink making the vein close and later disappear. After the vein is sealed shut, blood then naturally reroutes to healthy veins.

Venous reflux or venous insufficiency develops when the valves that usually keep blood flowing out of your legs become damaged or diseased and the VNUS system is ideal for sorting out this problem.

The ClosureFAST™ catheter (VNUS Closure Fast) ablates (heats, shrinks and closes) the vein in 7cm segments with 20-second treatment cycles. This makes the procedure very straightforward for the surgeon to perform, allowing the treatment to be performed very quickly. Unlike the other endovenous procedures, this technique closes the vein in segments. With other endovenous procedures the surgeon has to continuously pull the tube that is heating the vein and if he pulls it too quickly not enough time will be allowed to heat the vein for long enough and close it completely. On the other hand, if the surgeon pulls the tube too slowly there is an increased risk of damaging adjacent structures, by overheating the area for too long. These risks do not exist with the VNUS procedure.

Data from a prospective multicentre study have shown 97.4% vein occlusion 1 year post-treatment.

ClosureFAST™ Procedure Animation Video

Q.What is Radiofrequency Ablation?

A. This is now the gold standard in minimally invasive treatment for varicose veins. A very small tube (catheter) is passed up the main diseased/dilated/varicose vein via a needle sized puncture in the skin. Radio Frequency (RF) energy is delivered via this tube. This energy heats up the collapsed vein making its walls stick together, sealing the vein. The vein will then fade away into the surrounding fat.

Q. What is superficial venous reflux?

A. Superficial venous reflux develops when the one-way valves that are supposed to keep blood flowing away from the legs towards the heart stop working properly. This causes blood to move more slowly and pool in the leg veins. The legs may then feel heavy, painful and swell up. The veins in which the blood collects become larger, tender and more prominent. These are known as varicose veins.

Q. How does Radiofrequency Ablation work to treat superficial venous reflux?

A. The superficial veins are not essential and so, since the valves cannot be fixed, the best treatment is to remove the diseased veins. The blood will still find its way back to the heart via the deep veins. Until recently, removing these veins involved an open operation under a general anaesthetic. The main diseased vein is pulled out from the groin to the knee using a metal or plastic rod. This causes lots of bruising and pain after the operation – the patient has to wear special stockings for a six week period. The Radiofrequency Ablation procedure is a much less invasive/aggressive alternative to open surgery. Radiofrequency energy will obliterate the lumen of the diseased main veins. Other healthy superficial and deep veins will take over the job of carrying blood away from the legs and the treated diseased vein will fade away.

Q. What happens to the treated vein left behind in the leg?

A. During this minimally invasive procedure radio frequency energy is applied to the inside of the vein via a small tube/catheter. The vein is emptied of blood during this manoeuvre – by compressing it with an ultrasound probe and tilting the patient head down so that the blood moves towards the heart. The local anaesthetic injected in the leg also compresses the vein. The Radio Frequency energy heats up the walls of the vein, which then stick together, obliterating its lumen. Instead of a tube that carries blood, the diseased vein becomes a tin shrivelled solid cord. With time this will fade away into the surrounding fat. In around 9 out of 10 patients the remains of this obliterated vein will be untraceable after one year.

Q. How is the Radiofrequency Ablation procedure different from open surgery?

A. During open surgery, commonly referred to as stripping, a cut with a scalpel is made in the groin and deepened to identify the junction of the main superficial vein (the diseased vein) with the deep vein (non-diseased vein essential for blood return from leg to heart). The top part of the superficial vein is tied off to separate it from the deep vein. A metal or plastic rod (known as the stripper) is threaded down the superficial diseased vein (the medical name for this vein is the saphenous vein) and retrieved via another cut around the inner side of the knee/upper calf area.

The stripper is then used to pull out the diseased saphenous vein out of the thigh from groin to knee level. The Radiofrequency Ablation procedure removes the need for groin surgery. It is performed under local anaesthetic as an out patient procedure. This greatly reduces the cost of the procedure, making it affordable to everyone (not just patients with private medical insurance). The vein remains in place and is obliterated using radio frequency energy as described above. Using ultrasound, the diseased long veins are identified in the leg. A small needle (similar to what one uses to take blood) is inserted into these veins. Over a very fine wire, this is changed to a small tube through which the radio frequency fibre is introduced. Under ultrasound guidance the fibre is advanced to just below the junction of the superficial vein with the deep vein. The area around the fibre is then injected with local anaesthetic – this eliminates any pain during the procedure, compresses the vein and protects the skin above the vein from heating up. Radio frequency energy is then applied via the fibre to the entire length of the diseased vein.

With open surgery, vein stripping tears all the side branches of the veins that are stripped out. Pulling the saphenous vein out of the skin gives rise to quite impressive bruising. This is not the case with Radiofrequency Ablation where bruising and post operative pain are a rarity. Another advantage of VNUS over open surgery is that since there is no groin operation, there is no risk of problems with groin wound infections, breakdown or fluid leakages (seromas) which are not uncommon in patients having second or third operation for their veins. Besides, the reason why I prefer Radiofrequency Ablationis over Laser is because radiofrequency requires lower temperatures than laser to close the veins. I find that this causes less collateral damage and thus gives rise to less bruising and pain during the follow-up period.

Q. How do the results of Radiofrequency Ablation compare with traditional vein stripping?

A. Radiofrequency Ablation has long-term results that are at least as good as that of open surgery. It also has the added advantage of much less post- operative pain, bruising and scarring. Recovery and return to normal activity (including getting back to work) are much quicker. In my opinion open surgery should not be performed in this day and age.

Q. How long does the Radiofrequency Ablation procedure take?

A. The procedure itself takes around 30 minutes or an hour if combined with ambulatory phlebectomies (multiple avulsions). Patients do however spend around 3 hours at our hospital due to normal preoperative preparation and assessment and postoperative monitoring.

Q. Is the procedure painful?

A. Patients report feeling little, if any, pain. Local or regional anaesthetic can be used to numb the treatment area.

Q. How quickly after treatment can one return to normal activities?

A. Most patients can resume normal activities immediately. I advise my patients to wear a stocking for two to five days following treatment, as well as to try and walk as much as possible during the next six weeks. Prolonged periods of standing should be avoided.

Q. How soon after treatment will the symptoms improve?

A. Most patients report relief from their symptoms within two weeks.

Q. Is there any scarring, bruising, or swelling after the VNUS Closure procedure?

A. There is minimal to no scarring, bruising, or swelling especially when compared to other available treatments for managing this condition – compared to vein stripping and laser treatment.

Q. Are there any potential risks and complications associated with Radiofrequency Ablation?

A. As with all medical intervention, potential risks and complications exist. This is why it is vital that patients choose a specialist vascular consultant surgeon with a sub speciality interest in endovascular surgery to perform this procedure. Potential complications can include phlebitis, haematoma, infection, paresthesia (numbness or tingling) and/or skin burn.

Q. Is age an important consideration for Radiofrequency Ablation?

A. No. This procedure should be suitable for most adults with varicose veins. In some exceptions the veins may be too tortuous to advance the radio frequency catheter or too large to compress and allow wall apposition for sealing of the vein lumen. In such cases one may recommend open surgery over this procedure. This is however an extremely rare event at the Manchester Vein Centre, where e have been able to treat all our patients using endovenous means for te past three years.

Q. How effective is Radifrequency Ablation?

A. Published literature in surgical journals shows that this procedure is at least as effective as open surgery over the study period. It also has the added benefit of much less pain, a very quick recovery, minimal scarring and bruising and a much quicker return to normal activity.

Q. What is the difference between RFiTT and VNUS?

A. Although both RFiTT and VNUS use radiofrequency energy to close the refluxing vein, there are some subtle but important differences between the two techniques. The VNUS catheter has a 7 cm long end, which heats up to 120°C for 20s. At this temperature the vein is permanently destroyed. Some specialists would however argue that this is thermal (heat) ablation as opposed to true radiofrequency ablation. This means that it may be more similar to laser than RFiTT. For patients with relatively straight veins the VNUS catheter allows us to perform a quick painless procedure with excellent results. In very tortuous veins or where only a short segment of vein needs treatment, the VNUS catheter may not be suitable. The RFiTT catheter has a much shorter tip, generating temperatures between 65 and 100°C. The power (wattage) and its duration is controlled by the clinician. With this technique it is the radifrequency energy rather than the heat that closes the refluxing vein. At the Manchester Vein Centre we have found that this technique gives the operator much greater control over the way the treatment is delivered, allowing us to tailor the delivery of energy depending on the vein's size and location. This way we achieve better results with less post-operative discomfort.

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