Chapter: Invasive therapy
Article: 6 of 15
Update: Feb 07, 2021
Author(s): Müller-Wille, René
Endoluminal procedures such as endovascular laser therapy (EVLT) or radio frequency ablation (RFA) are used in the minimally invasive closure of large dysplastic veins in complex venous malformations. A flexible laser or radiofrequency probe is inserted through an airlock (guiding sheath) directly into the dysplastic vein. Slow retraction of the probes during laser or ablation results in sclerosis of the vascular wall of the entire treated vessel area due to heat generation, and ultimately in closure of the vessel.
The basic prerequisite for the closure of superficial dysplastic veins is the patency of the deep venous system. If the deep venous system is not properly developed or absent, the closure of the superficial veins can even lead to a worsening of the situation, as all the venous blood is drained via the superficial system and the blood can no longer drain off adequately. During use of these procedures, which ultimately work by locally heating the vessel wall, superficial burns or damage to surrounding nerves can also occur. For this reason, a protective water cushion (so-called tumescence) is usually applied around the treated vein by the injection of saline solution, which can also be mixed with local anesthetic and vasoconstrictor agents.
In principle, endoluminal coagulation is associated with a risk of deep vein thrombosis, which may have to be counteracted by postoperative compression therapy and prophylactic anticoagulation. After endovascular laser therapy or radiofrequency ablation, local brownish skin discolorations along the coagulated vein may occur for a matter of weeks or longer.