Edward G. Mackay, MD, FACS, RPVI, RVT, offers up-close expertise through an instructional video on Radiofrequency Ablation of Saphenous Vein. Presented during a recent International Vein Congress, Mackay walks viewers through a brief procedure on a woman with "fairly straightforward" and typical varicose veins.

The intervention involves fixing an incompetent anterior accessory saphenous vein using radiofrequency closure. The patient's great saphenous, he said, had been spared and is quite small, "but the anterior is quite large," up to 18mm just below the junction. A phlebectomy of the secondary clusters was set to follow.

Dr. Mackay begins the procedure by numbing the patient's skin with local anesthesia. He also sticks the vein itself and follows with more anesthesia. Before long, it's evident that anesthesia starts to surround the vein.

Next, Dr. Mackay puts the introducer sheath in place for the closure catheter to go through and estimates the length of the closure catheter treatment section needed. An ultrasound confirms positioning, and he watches for the junction.

More numbing is applied. The tumescent anesthesia, now surrounding the vein, is clearly seen on the scan. The catheter is in the middle of the vein, and the needle is just above. The needle is placed behind the vein to ensure it is surrounded completely. The 18-mm vein has been compressed and is quite small. More tumescent anesthesia is applied prior to the phlebectomy, after the closure.

Next Dr. Mackay heats up the catheter 120 degrees to close the vein. He pulls the catheter back to the subsequent mark to do the next section and once again, the temperature rises to 120 degrees. Dr. Mackay pulls the sheath out, leaving the catheter treatment portion in the vein and that completes the closure. The color duplex ultrasound shows some flow in the junction, but not in the saphenous vein. The video concludes as Dr Mackay prepares to move on to a phlebectomy.

The video, available at Vein Global, is one of more than 200 on demand instructional, inspirational and innovative presentations by leading venous professionals. Learn more and subscribe at VeinGlobal.com.