Radiofrequency Ablation

Definition

Radiofrequency ablation is a medical procedure in which a needle electrode, charged with radiofrequency current, is used for the removal of different types of tissue. This procedure is considered to be minimally invasive and it is based on the heating process of the respective tissue, which makes the removal easier.

What is radiofrequency ablation used for?

These are the most common medical complaints for which the radiofrequency ablation can be used:

• Cancerous growths – radiofrequency ablation can be used to remove tumors from different organs and parts of the body, including the bones, kidneys, liver and lungs; more recently, for pancreatic and bile duct cancer
• Cardiac disease – radiofrequency ablation is used in the following conditions of the heart:
• Cardiac arrhythmia (ventricular)
• Atrial flutter
• Atrial fibrillation
• Supraventricular tachycardia
• Atria tachycardia
• Multifocal atrial tachycardia
• Dermatological problems
• Treatment of skin lesions (aesthetic importance)
• Varicose veins – treatment of the following:
• Great saphenous vein
• Small saphenous vein
• Perforator veins
• Obstructive sleep apnea
• Pain management – treatment of: Severe low back pain
• Barrett’s esophagus (medical condition in which the lower portion of the esophagus presents abnormal changes)
• Interruption of nerve conduction (radiofrequency lesioning)
• Liver resection
• Treatment of TRAP sequence (multiple gestation pregnancy)
• Uterine fibroids
• Morton’s neuroma (medical condition in which a benign tumor formed out of nerve tissue appears between the intermetatarsal spaces).

Benefits

These are the benefits of the radiofrequency ablation:

• It is a minimally-invasive procedure, being performed in an outpatient setting and with local anesthesia (conscious sedation anesthesia might be used in some patients)
• Better and shorter recovery time, due to the reasons specified above (patients can go home shortly after the procedure or they require a very short hospital stay)
• Does not stimulate the nerves or the muscles of the heart in a direct manner, which means that no general anesthesia is required (hence the usage of local anesthesia) – no risks associated or caused by general anesthesia
• It can address exactly the problem at hand, without the fear of damaging surrounding tissues (direct targeting at the desired tissue)
• When radiofrequency ablation is used for aesthetic purposes, it offers the following advantages: very few or minimal side-effects, reduced risk of complications
• High success rates in the treatment of varicose veins, with low chance of complications.

Procedure

As it was already mentioned, for this procedure, the doctor will use local anesthesia or a mild sedative. The medication for the anesthesia is administered through an intravenous line. The patient is lying on the table and the area in which the procedure is going to be performed will be thoroughly cleaned, with special substances that have antiseptic properties. A local anesthetic is going to be applied to the skin as well.For the procedure itself, the surgeon will use fluoroscopy or X-ray guidance, in order to make sure that the radiofrequency needle targets exactly the desired tissues. Then, a small amount of electrical current is going to pass through the respective needle, heating the targeted tissues and allowing for their easy removal. Depending on the area in which the procedure is going to be performed, the radiofrequency ablation can last from half an hour to one hour and a half.

How to prepare for radiofrequency ablation

In order to be prepared for the radiofrequency ablation procedure, you should talk to your doctor and mention all the medication you are taking. You will also have to mention if you are allergic to anesthesia or to the different materials that might be used during the intervention, such as the iodine which is used to clean the surgical field or the radiologic dye, commonly used for fluoroscopy. Before the procedure, you might need to avoid taking certain medication, such as aspirin, NSAIDs or blood thinners, as these can increase the risk of hemorrhage during the procedure.The doctor will also perform a series of tests to determine the state of overall health, especially the state of the heart and the kidneys. In case of pregnancy, you should talk to the doctor, as the fluoroscopy procedure can damage the fetus. The doctor will take the necessary precautions, in order to minimize the exposure of the unborn baby to radiation.With one night before the actual procedure, you will have to avoid eating or drinking anything. After the procedure, you might feel a little bit groggy, so you need to have someone waiting and take you home.

Recovery time

As it was already mentioned, given the fact that the procedure is minimally-invasive, the recovery time is considerably reduced in comparison to traditional interventions. Many patients go home in the same day with the procedure or they remain in the hospital for no more than a day. However, you must take things slowly, as you will experience some soreness in the area of intervention for about one week. The doctor will probably recommend to apply ice packs, in order to reduce that discomfort. The discomfort will subside in a couple of weeks and you will need to avoid strenuous physical effort, in order to promote an efficient healing process.

Cost

In speaking about the costs of this procedure, you will have to take into consideration several factors: the clinic/hospital in which the procedure is performed, fees of the doctor and other medical staff, anesthesia-related fees and prolonged hospital stay, in case of unwanted complications. You will also have to check your insurance policy and see if you are covered (partially or totally) for such procedures. You should also keep in mind that the overall costs differ according to the area which is operated. On average, you can expect to pay $4000-$5000 for such a procedure.

Side effects

These are the potential side-effects of radiofrequency ablation:

• Pain or discomfort
• Numbness (loss of sensation) in the area of the procedure
• Muscle spasms
• Nerve pain (permanent or transient)
• Infection
• Sunburn type pain (nerve irritation)
• Hypersensitivity of the skin (local)
• Tearing of the tissues, due to the wrongful application and the overheating of the respective tissues

Radiofrequency ablation for: Varicose veins

Radiofrequency ablation can be used as a minimally-invasive procedure for the treatment of varicose veins. It represents a far better alternative to the traditional surgical intervention, guaranteeing a better and a faster recovery. For this procedure, the doctor will use ultrasound guidance, placing a radiofrequency catheter into the vein that needs to be treated. The radiofrequency ablation allows for the closure of the varicose vein, being recommended for three veins in particular: great saphenous vein, small saphenous vein and perforator veins.Before the actual procedure, the doctor injects a large quantity of anesthetic substance into the respective vein. Apart from eliminating the pain and discomfort experienced by the patient, this also reduces the risk for complications, such as burns on the skin (the anesthetic substance absorbs the excess heat). The procedure is preferred to other methods of treatment for varicose veins, given the number of successful cases and the reduced rate of side-effects.

Back pain

Patients who suffer from severe, chronic low back pain can benefit from treatment through radiofrequency ablation, the procedure being known as rhizotomy. What happens is that the heat resulted from the use of the radiofrequency needle acts on the nerves that are irritated at the level of the lumbar spine. The nerve is practically ablated and no longer able to transmit pain signals to be brain, thus improving the symptoms experienced by the patient and the overall quality of life.Before the radiofrequency ablation, the doctor will administer the local anesthetic, which is commonly represented by lidocaine. The purpose of the local anesthetic is also to identify the nerves that are irritated in the lumbar spine. It is said that the radiofrequency ablation is going to be performed only on the nerves that have shown a positive response to the administration of the local anesthetic.Just like in other medical problems, the radiofrequency ablation for back pain is an outpatient procedure and the patient can go home in the same day of the procedure. There are no risks associated with general anesthesia and the recovery is quite efficient. The problem is that it represents only a temporary solution, as nerves tend to regenerate with the passing of time, causing the same symptoms (short duration of treatment, ranging between half a year and two years).

Cancer

The usage of radiofrequency ablation for cancerous growths has increased in the past few years, with cancers of the kidneys, liver or lungs being treated successfully through such methods. Bone cancer and cancers of the bile ducts or the pancreas have also been treated through radiofrequency ablation. The treatment is recommended after the positive diagnosis of cancer; just like in the other procedures, the radiofrequency needle will reach the tumor through imagistic guidance and heat the respective tissues until they are destroyed and easy to remove.It is important to note that a procedure such as radiofrequency ablation is mainly recommended for tumors of small size, primary or secondary (metastases). In deciding whether radiofrequency ablation is a suitable procedure or not, the doctor will take into consideration a series of factors, including: age of the patient, extensiveness of the tumor and other pre-existing conditions.Even though it is an outpatient procedure, the patients treated for cancer might require a brief hospital stay. In many cases, the doctor might decide to combine radiofrequency ablation with other methods of treatment, such as chemotherapy (thus increasing the chances for success). Such combinations are often used for the treatment of patients who have been diagnosed with hepatocellular carcinoma.

Heart

In patients who suffer from diseases of the heart, radiofrequency ablation is generally used with the purpose of changing electric pathways that are not normal and lead to a modification of the cardiac rhythm.For this procedure, the doctor will insert the radiofrequency needle through a small catheter, which has been placed inside a vein. Before the actual procedure, the surgeon will identify the exact location of where the abnormal electrical pathway occurs. There are different conditions of the heart that can be treated through this method, including: atrial flutter, supraventricular tachycardia and atrial fibrillation. Recent studies have shown that radiofrequency ablation might also be used with success in those who are suffering from chronic or drug-resistant hypertension.

Liver

As it was already mentioned, radiofrequency ablation is a common procedure performed in patients who have been diagnosed with chronic liver disease or cancer. It is a procedure recommended in patients who have been classified as inoperable through other methods and it is often used in combination with other forms of treatment, such as chemotherapy (increased chance of success and prolonged survival).It is important to understand that, in patients diagnosed with cancer of the liver, this procedure is palliative, providing relief from the symptoms. Even though it may shrink the size of the tumor, it cannot cure the cancer the patient is suffering from. However, it can improve the rate of survival, especially when it used in association with other forms of treatment.

Neck pain

Radiofrequency ablation can be used with success for the treatment of neck pain. The procedure is minimally-invasive and it works by targeting the spinal nerves that are irritated in the cervical area. In a similar manner to the procedure used for the low back pain, the radiofrequency needle will ablate the cervical nerves and improve the symptomatology of the patient. It is important to note that the pain relief provided by the radiofrequency ablation is superior to the one offered through other methods of treatment (nevertheless, the effect is temporary, as the nerves will regenerate with the passing of time). This procedure is recommended in those who are suffering from neck pain, due to: whiplash injury, neuropathic pain syndrome, entrapment of the spinal nerves, prior surgical intervention in the cervical area and inflammation at the level of the spine. In general, the rate of success is high and the risk of complications reduced. Physical therapy might be recommended for a better recovery after the intervention.