Radiofrequency Closure and Laser Ablation of the Great Saphenous Veins and Tributaries

Changes in insurance policy allow us to offer these techniques for the treatment of an incompetent Saphenous Vein (Great Saphenous, Short Saphenous, Tributaries and perforators) associated with varicose veins. Currently, Medicare and almost all other insurance companies cover the procedure. The GSV is the largest and longest of the superficial veins and lies within a sheath in the fatty layer between the skin and the muscles of the thigh and leg. It originates from branches of the foot and medial aspect of the ankle and terminates at the common femoral vein in the groin (the saphenofemoral juncture-SFJ). Large tributary varicosities on the anterior and medial surface of the leg connect with the GSV. The dysfunctional valves within the GSV create dilatation and subsequent varicosities of the branches. The GSV will cause congestion of the veins and tissues resulting in symptoms that will prompt patients to seek medical advice. Ultrasound scans of the GSV are usually necessary to diagnose the incompetent GSV. Incompetence causes the blood within the GSV to flow backwards, stagnate and eventually to clot (thrombophlebitis). Early symptoms include swelling, leg fatigue, throbbing pain, restless legs and cramps at night. Advanced symptoms include bulging varicose veins, painful varicose veins, ankle pigmentation, dermatitis, cellulites, subcutaneous sclerosis, ulcers and thrombophlebitis. Incompetence of the short saphenous vein will cause almost similar symptoms.

Treatment Objectives
The goal is to obliterate the saphenous vein or tributary at the highest point of valvular reflux which is usually at its respective juncture with the deep veins. The techniques ablate the veins by the heat generated at the tips of the  radiofrequency (RF) catheters or Laser fibers.

Technique
The procedure is performed in an outpatient surgical suite in the office. Anesthesia is local lidocaine with light sedation. This allows the patient to be awake and able to ambulate after the procedure. A sterile field is established to include the extremity and surrounding area. A small spot on the lower leg or ankle is anesthesized with lidocaine in order to introduce the catheter into the saphenous vein. The catheter tip is advanced to the juncture,  the groin for the long saphenous vein or behind the knee for the short saphenous vein. There is little sensation of pain as the catheter is advanced through the vein. Additional lidocaine is injected along the entire length of the saphenous vein to concentrate the heat on the inner walls of the vein and prevent pain and damage to adjacent tissues. The catheter is slowly withdrawn from the vein while heating the vein walls. The ultrasound is used throughout the procedure: it allows us to accurately place the tips of the catheter at the juncture and follows the catheter as it is withdrawn. Varicose branches are next removed using the stab avulsion method. Bandages are applied and the patient is allowed to ambulate.