Interesting Scenarios during Radiofrequency Ablation of Varicose Veins at University Hospital of Nepal

Table 2

Interesting scenarios during RFA of varicose veins.

S.N.	Interesting scenarios	Number of cases	Remarks
1	Double GSV	4	It was missed in one case which resulted in early recurrence. In the remaining three cases, RFA was done using an “alternate RFA technique” (Figure 2)
2	“Shy GSV phenomenon”	15	For these cases, we tried for two settings of puncture with a cannula. If cannulation failed due to spasm, then we opted to use an open method for cannulation. RFA is done in the proximal segment, and ligation is done in the distal part
3	Recurrence due to a lymph node vessel	1	Ligation of the lymph node vessel was done after identification of the vessel with the help of ultrasonography
4	GSV too tortuous/angulated or thrombosed so that single-catheter RFA could not be done	12	A double-prepuncture technique (Figure 12) was done in 10 cases. In the first two cases as this technique was not used, it was difficult to do proximal cannulation following RFA of the distal segment
5	GSV and deep system too close (<1 cm)	7	A total of 7 cases were identified and were treated with infusion of 10 cc normal saline to increase the space between the GSV and deep system which increases the distance and also prevents the DVT