Recommendations and Appropriate Solutions to Difficulties During the Endovenous Radiofrequency Ablation Process for Lower Limb Varicose Veins Management

Abstract

Background: Endovenous radiofrequency ablation (EVRFA) is a highly effective, minimally invasive treatment for lower limb varicose veins, though operators frequently encounter intraoperative challenges that require real-time problem-solving. This study aims to document these specific intraoperative challenges using the ClosureFAST™ system and evaluate the efficacy of standardized corrective strategies on procedural success and patient outcomes.
Methods: A cohort study was conducted involving 480 patients who underwent a total of 680 great saphenous vein (GSV) ablations between April 2013 and October 2020. The study recorded ten predefined procedural challenges including misleading duplex imaging, venous spasm, tortuous segments, and superficial veins alongside the specific corrective measures deployed. The primary endpoint was technical success, defined as complete segmental occlusion confirmed by duplex ultrasound at 6 months.
Results: The most frequent intraoperative challenges encountered were ineffective first-cycle RFA (97.9%), tortuous or recanalized segments (20.8%), superficial vein courses (20.8%), and venous spasm (12.5%). Applying targeted corrective actions—such as on-table duplex re-mapping, anesthetic and positional adjustments to abolish spasm, phased ablation via dual punctures, and focused manual compression—successfully overcame these hurdles. Ultimately, technical success at 6 months was achieved in 99.4% of the treated veins (676/680). Furthermore, standardizing the protocol significantly reduced mean procedure times from 55 to 42 minutes, with zero major adverse events reported.
Conclusion: Implementing systematic, algorithmic corrective measures for common EVRFA challenges minimizes complications and significantly enhances procedural efficiency. This standardized approach provides a highly reproducible framework that ensures patient safety and maximizes the technical success rates of endovenous thermal ablation.