Most vein surgery procedures are performed using radiofrequency therapy

 

Since our institute began specialising in modern vein surgery in 1992, we have always maintained a complete overview concerning all current processes and are even active in the scientific investigation of these procedures as well. The director of the institute, Dr. Florian Netzer, has educated physicians in the modern surgical methods used in varicose vein treatment for many years and holds lectures at national and international congresses every year on these topics for the specialised public.

Because of this profound knowledge of all the advantages and disadvantages of the presently available methods, we predominantly perform vein treatments at our institute today using radiofrequency therapy. We combine this process, if necessary, with other procedures so that a tailor-made therapy emerges for the individual case, which is, throughout Europe, offered only at our institute with this type of combination during one and the same treatment.

Conventional Techniques

It has been shown that the radiofrequency catheter procedure itself – when it is carried out very precisely and with a great deal of experience – is the most gentle of vein treatments, well ahead of the conventional stripping, the CHIVA process and the laser catheter:

• With the conventional stripping, there is extensive tearing of the tissues and subsequent haemorrhaging: The period of inactivity after the vein surgery lasts for a number of weeks and one must wear compression stockings for up to 12 weeks long. Equally long, the patients are unable to participate in sport, nor are most of them initially able to stand for longer than only a few minutes without having to elevate their legs once again, because of the tendency for their legs to become swollen and the sensation of pressure. Naturally, that improves gradually, but the impairment is nevertheless considerable. Furthermore, this process is of course also associated with the development of scars.

• With the CHIVA method, very many, often large incisions are required and compression stockings must be worn for an extended period here as well. Aside from that, the need for repeated vein surgery following this process is also extremely high. In our institute, we treat many patients year after year who once underwent CHIVA surgery and then subsequently developed new varicose veins very quickly. Of course, the basic idea of conserving the superficial truncal veins is theoretically very good, but practice unfortunately shows that new varicose veins develop again very quickly. In addition to the original CHIVA surgery, patients must repeatedly be operated on afterward and frequently suffer from numerous scars which prove to be cosmetically disturbing. Likewise, inability to work for a lengthy period of time and a pause from participation in sports is to be expected after the CHIVA vein treatment.

• With the laser catheter, there are, as with the radiofrequency procedure, practically no scars to be seen, but this method is performed using temperatures of up to 1200°C at the tip of the catheter. Such temperatures are injurious for the surrounding tissues and very frequently lead to inflammations after the vein surgery. Through the high temperature of the laser treatment, there is an explosion-like evaporation of the blood from the tip of the catheter which leads to tears in the vein being treated. Blood is consequently able to flow into the surrounding tissues and very extensive haematomas may develop, as are otherwise only know to occur following a crude stripping. A further problem is the release of laser energy per surface area of the vessel being treated, which cannot be standardised nor objectively controlled: The operator can only treat "according to his/her feeling" so that some portions of the vessel are heated too intensively and some too little.

 

However, the precise nature of the procedure requires a great deal of experience and much routine practice. The accurate placement of the tip of the catheter at the site of the junction between the superficial and deep venous systems is extremely important and also not very easy – placement of the catheter which is too deep can cause damage to the deep vein, which is necessary for life, while a placement which is too shallow and not close enough to the junction, on the contrary, leaves behind a stump of the superficial vein which is too long and can very quickly lead to the development of new varicose veins ("relapse").

Only a truly experienced vein surgeon will always find the right position of the catheter here. In our institution, we perform up to 10 of these operative procedures daily and consequently have sufficient experience.

Because modern processes (in contrast to time-honoured methods) must first of all be proven scientifically, the radiofrequency procedure has undergone many scientific, very precise studies concerning the efficacy, the possible side-effects and the long-term results of the vein treatment.

Thereby, the process has proven to be so good (in comparison with traditional methods) that in the (binding for surgeons) "Guidelines of the German Society for Surgery", it has even received the supreme reward for scientific verifiability and recommendation of "Evidence level A". In comparison, stripping, which was already employed in 1907, only received the "Evidence level B".

For these reasons, we have utilised the radiofrequency vein treatment technique daily for many years and have collected excellent results with its use. Obviously, our institute also makes use of all scientifically tried and tested methods which have been found to be good (for precisely that very reason, the CHIVA process is no longer being used). However, it has been shown that we can serve our patients best with the radiofrequency procedure: It offers the shortest recovery time following treatment (most patients are ready to work once again on the day after their vein surgery), legs which are free of scars, and requires that compression stockings be worn for only one to three days.

Our patients, practically without exception, are fully able to work again and participate in sports on the day after their vein treatment (naturally, depending on the particular work, individual cases and type of sport).

To be able to produce optimal medical and aesthetic results, we combine different processes selected during an intraoperative consultation; like, for example, the radiofrequency procedure, the laser treatment for spider veins, the endoscopic removal of the truncal veins and, possibly, the microfoam method. In this way, we are able to attain the best results in a gentle manner.

 

Comparison of conventional stripping methods and radiofrequency therapy

 

Further information material:

FAQ on laser and radiofrequency therapy