Dr. Alexa Mordhorst, a vascular surgeon at the QEII, is part of the team working to bring radio frequency ablation to the QEII for treating chronic venous disease, which occurs when varicose veins become problematic and can cause significant health problems. RFA is a quick, non-invasive, in-clinic procedure that is easier on patients and more cost effective for the healthcare system. CONTRIBUTED
QEII launches Atlantic Canada’s first initiative for Chronic Venous Disease patients
A variety of images come to mind when you hear the term varicose veins. Big, sometimes bulging blue veins, which can make those with them feel self-conscious. But the issue isn’t always just skin deep — varicose veins can be dangerous.
When varicose veins become problematic, it’s a condition known as chronic venous disease (CVD). CVD can cause significant health issues that may result in very severe problems for people, ranging from chronic pain to open wounds that don't heal, as well as impacting their daily function, potentially their careers.
Dr. Min Lee, the division head for vascular surgery at the QEII Health Sciences Centre, and her team are currently pursuing a technology to make a quick, in-clinic procedure available to CVD patients called radiofrequency ablation.
“Radiofrequency ablation (RFA) uses heat to cauterize the problem vein,” says Dr. Lee. “We use an ultrasound to visualize the vein, usually from about the mid-calf or around the knee area. We identify the vein, put our catheter in there, inject freezing along the course of the vein and then we use heat through a machine to basically cause a vein to burn itself closed. It's not high tech. The beauty of the RFA is that the machinery is very simple.”
The current option in the public healthcare system for those suffering from CVD is a surgery called vein stripping, where the problem vein is removed via an invasive surgery, leading to at least a week of recovery for the patient and using operating room time and resources which are already stretched thin, creating surgical wait times spanning years. Right now, approximately 1,000 patients are waiting to have their veins assessed. Healthcare teams are challenged with prioritizing procedures that are limb or life-threatening ahead of vein stripping for varicose veins.
Dr. Lee nods to Nova Scotia Health’s recruitment of two physicians with fellowship training in venous disease — Dr. Alexa Mordhorst and Dr. Adam Power — for the renewed push for the RFA equipment. Dr. Mordhorst, a vascular surgeon at the QEII, believes treating the problem vein at the source is much less burdensome to patients.
“For RFA, we don't need an operating room or an anesthesiologist, which we do need for vein stripping,” explains Dr. Mordhorst. “The patient walks into the procedure room, and they walk right out. They can go to work the same day if they need to — there’s no down time. RFA is done with a little needle poke, no cuts or incisions. It’s so much easier on the patient and the healthcare system.”
There are only two provinces in Canada that currently provide the RFA procedure within the public healthcare system — Saskatchewan and British Columbia. Currently, if a Nova Scotian with CVD wanted radiofrequency ablation to treat their problem veins, they would need to seek treatment from a private clinic, which Dr. Mordhorst says can be a financial barrier for most.
“Having RFA done on both legs in a private clinic can cost close to $10,000. The reality is most patients cannot afford to get that treatment privately. If they don’t get treatment and their varicose veins get worse, then their life gets worse — they could lose or need to change jobs, which can create more problems. It becomes a vicious cycle. Bringing RFA to the QEII is going to help a lot of people in Nova Scotia.”
Dr. Lee notes chronic venous disease affects up to 50 per cent of adults but disproportionately impacts women and those whose careers have them on their feet much of the day.
“While we see both men and women, women tend to develop this more because of hormonal changes that happen, particularly in pregnancy, and then it tends to get worse over time,” says Dr. Lee. “Women often have jobs that are predisposed to standing for long periods of time, like caregiving, nursing, daycare workers, etc. In these female-dominated jobs, we see a lot of patients with venous issues. We are looking forward to being able to offer RFA to those who are experiencing complications and severe symptoms related to venous insufficiency.”
“We have come to this hard point where we know venous disease is a bad problem here, but it's very hard to treat when we're always limited by operating room resources,” says Dr. Mordhorst. “If we have an opportunity to treat varicose veins in the clinic instead of during our operating room days, it really opens the door to start moving these varicose vein patients through the system.”
Funding radiofrequency ablation equipment is part of the QEII Foundation’s We Are campaign, raising $100 million to transform health care through the QEII. By funding new equipment for RFA treatment, the QEII’s vascular surgery team can support more CVD patients, freeing up operating room time for those with life or limb-threatening conditions.
