Different techniques in radiofrequency ablation of varicose veins (traditional method and tumescentless method)

Introduction
Treatment of refluxing chronic venous insufficiency nowadays has entered a new era. Now, models of venous ablation with minimally invasive surgery have replaced surgery. Performing venous ablation requires the use of tumescent anesthesia instilled locally deep to the saphenous fascia. This application of tumescent anesthetic made the procedure lengthy with some difficulty. It is supposed that application of ice cold saline topically on the skin leads to anesthetic effect and absorbs the heat generated to the surrounding area and adds ease to the procedure as well.
Patients and methods
A total of 40 patients with Doppler-confirmed great saphenous vein insufficiency underwent radiofrequency ablation between July 2017 and May 2019. Patients were divided into two groups according to anesthetic management. Group A consisted of 20 patients who received tumescent anesthesia before the ablation procedure, and group B consisted of 20 patients who received local hypothermia and compression technique, and no tumescent anesthesia was administered. The visual analog scale was used and recorded. Clinical examinations were performed at each visit, and Doppler ultrasonography was performed in the first and sixth month.
Results
Mean ablation time was significantly lower in group B compared with group A. The immediate occlusion rate was 100% for both groups. Visual analog scale was higher in group B. All patients returned to normal activity within 2 days. The primary closure rate of group A was 90% and group B was 100% at 6 months, and there was no significant difference between the groups (>0.05) regarding primary closure, but there was a difference regarding the cost and length of procedure in favor of group B.
Conclusion
The topical application of ice cold saline during venous ablation led to less lengthy procedural time with effectiveness.