Radiofrequency-induced thermotherapy (RFITT) is a minimally invasive radiofrequency procedure used to treat varicose veins. In the RFITT procedure, the affected vein is sealed using a probe that generates an alternating current through the vein wall. This generates a temperature between 80 and 100 degrees.
What is radiofrequency-induced thermotherapy?
Surgeons typically remove abnormally dilated veins (varicose veins and spider veins) by making incisions in the skin. This is the oldest treatment method and is still used successfully today.
Since the end of the last millennium, however, a minimally invasive and gentler treatment method that does not require skin incisions has also been available. In this procedure, doctors seal off abnormally dilated veins from the inside. This includes radiofrequency-induced thermotherapy (RFITT).
When is radiofrequency-induced thermotherapy appropriate?
An important application for radiofrequency-induced thermotherapy is the treatment of varicose veins. But that’s not all—the RFITT method is also used in the following areas:
- Nasal turbinates
- Palate
- Base of the tongue
- Tonsils
The RFITT method is particularly popular for treating venous conditions because it does not require surgical removal of the vein.
Radiofrequency-Induced Thermotherapy (RFITT) is a minimally invasive thermal procedure used to permanently close varicose veins @ Svitlana /AdobeStock
How does RFITT work?
In the RFITT method, doctors insert a probe tip the size of a pinhead into the varicose vein. This is done via a puncture (small incision). Doctors then use high-frequency current (radiofrequency energy) to stimulate the vein wall from the inside. The heat (80–100 degrees Celsius) causes the vein walls to fuse together. The veins then close off.
RFITT is an endoluminal (acting from the inside) thermal (targeted heat application) procedure for treating varicose veins. The goal of the therapy is the permanent closure of the diseased veins.
Does the heat cause damage to the skin?
A special probe delivers controlled radiofrequency energy to the walls of the affected vein. The heat damages the vessel, leading to the sclerosis of the vein. This is followed by the complete closure of the varicose vein. After closure, the former vein is transformed into connective tissue, which the body then breaks down.
Damage to nearby structures is possible and is considered an undesirable side effect. For this reason, doctors inject a physiological saline solution containing local anesthetics around the varicose veins. In this way, they attempt to protect the healthy connective tissue.
This creates a protective layer around the vein. In addition, the injected saline solution also has a cooling effect. Treatment with the addition of local anesthetics is less painful for the patient.
A modern procedure that reduces unwanted side effects is the Celon method developed by Olympus. Continuous resistance measurement within the tissue regulates and controls the delivery of electrical current. This results in fewer burns.
How does the RFITT procedure using the Celon method work?
Vein treatment using the RFITT method is performed on an outpatient basis. First, the doctor and patient conduct a detailed medical history review.
The doctors then perform an ultrasound to accurately assess the condition. Before the actual treatment with radiofrequency-induced thermotherapy, the doctor provides the patient with detailed information about the risks and the procedure.
On the day of the procedure, the doctors perform another ultrasound scan of the veins. The patient stands while the doctors mark the pathologically dilated veins. The Celon method is performed under local anesthesia and takes about an hour in total.
After administering the local anesthetic, the doctors puncture the vein, make a tiny opening, and insert the electrode. This electrode delivers targeted radiofrequency current to the tissue. The current heats the area and causes localized coagulation.
During the procedure, doctors measure resistance to ensure proper current delivery. Continuous monitoring during the treatment ensures that the exposure time, energy level, and position are optimal.
An acoustic impedance signal ensures that surrounding tissue is spared during the procedure. An alarm sounds if inaccuracies are detected.
The treated vein undergoes thermal sclerosis during the course of treatment and contracts until it is completely occluded. The cellular fluid evaporates, and the vein is closed off. At the end of the procedure, doctors close the puncture site using surgical glue or a small suture.
After treatment, patients receive a firm compression bandage to ensure blood flow without clotting.
What are the advantages and disadvantages of the RFITT method?
Radiofrequency-induced thermotherapy is a minimally invasive procedure. Compared to surgical methods, it offers numerous advantages.
These include:
- Less nerve damage, especially in the groin area
- Fewer risks thanks to local anesthesia
- Less strain on the cardiovascular system
- Can be performed on an outpatient basis
- Minimal downtime due to rapid rehabilitation
- Good cosmetic results thanks to the absence of incisions and scars
This patient-friendly alternative to traditional varicose vein surgeries, such as stripping, can also have some drawbacks. These include, for example, temporary discoloration in the treatment area. This discoloration persists until the patient’s body has broken down the sclerosed veins.
Furthermore, not all public health insurance plans cover the costs of the therapy, which can result in financial burdens.
Complications and Side Effects of the RFITT Method
Doctors have been using RFITT procedures since the 1980s. The Celon method, in particular, is already a standard procedure in thermal therapy today. Compared to other methods, the procedure carries few risks and side effects when used to treat spider veins and varicose veins. Nevertheless, as with any other procedure, this minimally invasive technique carries risks of complications in individual cases, such as:
- Hypersensitivity and hardening of larger veins
- Development of varicose veins in the surrounding veins
- Inflammation or infection in the treatment area
- Circulatory collapse due to an allergy to anesthetics
- Burns to the skin’s surface
- Formation of blood clots
- Permanent nerve paralysis
The complications listed above are extremely unlikely with the Celon method. More common side effects, however, include dizziness, itching, or nausea caused by an overreaction to the anesthetic. Temporary sensory disturbances or transient pain are also among the more common side effects.
What is the post-treatment care after RFITT?
Since RFITT is a minimally invasive procedure, no special follow-up care is necessary. The patient’s ability to work is generally maintained, and the leg remains mobile.
Wearing a compression stocking is still recommended. Experience has shown that this leads to a subjective reduction in symptoms when worn during the day for the first 1–2 weeks. Sometimes pain relievers such as diclofenac (Voltaren®) are needed to relieve pain and reduce swelling.
After RFITT treatment, doctors sclerose any remaining spider veins on the leg using an alcoholic solution. This procedure is also known as sclerotherapy. It can also be performed on an outpatient basis without anesthesia.
Sclerotherapy means “sealing off” the varicose veins @ rh2010 /AdobeStock
Can varicose veins reappear after RFITT treatment?
The risk that varicose veins will persist or develop after RFITT treatment is 10 to 30 percent. This may be because the treatment was not successful and the vein walls did not seal together. In that case, repeat treatment with radiofrequency therapy may be necessary. Surgical treatment is also an option.
Even after successful treatment, new varicose veins may form (recurrence) if other veins in the leg dilate. This occurs more frequently in pregnant women, in particular. Family history also plays an important role.
Experts recommend that people at risk wear medical compression stockings. This can help prevent recurrences, especially during stressful situations such as long flights or car trips.