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Radiofrequency ablation is a process of heating a vein sufficiently so that the tissue contracts tightly during the heating process, closing the vein, and the cells in the vein wall die so that the vein can never reopen again. It is a catheter based treatment, which means that a very long, thin, tube is passed up inside the vein itself under ultrasound control. This long thin device is called a catheter. It is usually introduced into the vein through a single needle hole just below the knee. Sometimes, depending on anatomy, this site might vary. Because ultrasound scanning is now so good, provided there is a second person performing the ultrasound during the procedure, the top of the catheter can be placed precisely at the point where the target vein meets the deep system. As heat is going to be generated, it is important to put local anaesthetic around the vein. This is also guided by ultrasound. Local anaesthetic is injected around the vein in very large volumes, not only numbing the vein but also preventing any heat that is generated from affecting any surrounding tissue. This is called tumescence and it causes the vein to contract tightly onto the radiofrequency catheter. The patient is also tipped head down whilst lying on a couch to empty any residual blood from the vein to ensure very good contact between the radiofrequency catheter and the vein wall. When treatment is to start, the radiofrequency current is turned on. An electric current passes down the catheter into the electrodes positioned at the tip of the device. This allows an electric current to start passing into the vein wall. This current then switches direction, flowing the opposite way. Almost instantly, it switches once again and so on, changing direction thousands of times a second. This frequency of changed direction of current makes all of the electrons in the vein wall vibrate, generating heat. Because the frequency is thousands of times a second, and because radios work when current changes thousands of times a second, the electrical current is said to be operating at radiofrequency rates. Hence the term radiofrequency ablation. This vibration of the electrons in the vein wall generates sufficient heat to cause the proteins in the vein wall to contract, closing the vein and to kill the cells in the vein wall, making sure the vein cannot grow back again.

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