Authors’ own method of diathermic thermal ablation of venous perforators – surgery with protective tumescence

Objectives: Low-invasive endovenous thermal ablation techniques have become the preferred modality for the treatment of incompetent perforating veins.

Material and methods: We managed 210 varicose-vein patients (268 limbs) presenting with coexisting superficial and perforator incompetence. We utilised bipolar radiofrequency ablation for the treatment of incompetent superficial veins and monopolar diathermal ablation under protective tumescence to manage incompetent perforators. To ablate incompetent perforating veins with monopolar diathermy we used a modified peripheral intravenous catheter with a long needle for administration of tumescence.

Results: The success rate of thermal ablation of incompetent perforating veins, defined as completely occluded perforators demonstrated by Doppler sonography at one-year follow-up, was 95%. A similarly defined success rate of radiofrequency closure of incompetent superficial veins was 97%. There were no serious intraoperative complications such as deep vein thrombosis, peripheral nerve injuries, skin burns or persistent hyperpigmentations. There were transient hypoesthesias in 20% of patients presenting with incompetent Cockett I and Cockett II perforators. In addition, 96% of patients presenting with active ulcers had their ulcers healed 30-60 days after the procedure.

Conclusions: Monopolar diathermy with the use of protective tumescence enables minimally invasive, effective, and precise ablation of incompetent perforators. This method is also safe, with no associated injury to adjacent anatomical structures or thromboembolic complications.