Preoperative preparations

1. Generator: ECO-100E2 microwave therapeutic system (specialized in varicose veins)
2. or ECO-200G microwave therapeutic system (Tumor + varicose veins 2 in 1 generator)
3. Antenna: Disposable microwave therapeutic antenna
4. Ultrasound diagnosis system
5. 6F Sheath
6. Anesthetic tumescent (local anesthesia), tumescent fluid (spinal anesthesia)
7. Tumescent Pump (depends on specific generator）
8. Bandage

• Standard formula: 500ml Normal Saline (4℃) + 25ml 2% Lidocaine
• Optional additional formula: 8ml 5% NaHCO3 + 0.25mg Adrenaline

Surgical Procedures

1. Preoperative examination under ultrasound: Examine the patient with standing position by determining the source of reflux, assessing venous occlusion or thrombosis, marking the varicose veins.
2. In-operation position: The patient takes a supine position and bends the knee abduction;
3. Puncture point and puncture skills:

• The patient takes feet-down tilt position;
• Locate the puncture point under guided by ultrasound: the puncture point of the GSV (Great Saphenous Vein) is usually about 10cm above and below the knee joint;
• Use 1% lidocaine for local anesthesia at puncture-point;
• Seldinger puncture under guided by ultrasound;
• Measure the length of the antenna that insert to the vein along the leg, and then insert it under ultrasound guidance. Leave 2cm from the saphenous-femoral junction. If the GSV is distorted, slightly withdraw the antenna, and then slightly smooth the blood vessel with finger.

Inject anesthetic tumescent

1. Patient takes trendelenburg or the supine position;
2. Connect a long local anesthesia needle and inject anesthetic tumescent along the GSV under ultrasound guidance;
3. The interval between the injection points on the surface of the skin depends on the length of the needle (usually equal to the length of needle). Anesthetic tumescent that insert into GSV should be between the deep and superficial fascia and evenly wrap the vein around;
4. After the injection of anesthetic tumescent, ultrasound examination is performed to confirm that the tumescent fluid surrounds the GSV trunk of the treatment section to provide thermal insulation protection.

Microwave ablation

• Confirm again and adjust the position of the microwave antenna tip;
• Turn on the unit, set the power and time parameters, and microwave ablation will be performed under ultrasound guidance, and the highlight development can be seen when ablating.

The protocol is as below:

• If there is a venus dilatation in the GSV, add 4-5s ablation time;
• When the antenna tip is 1cm away from the soft sheath, the sheath needs to be withdrawn first.

Post-operation Treatment

1. Use compression bandage at the affected limb and wrapped by an elastic stocking after surgery; Remove the bandage 7 days after ablation and continue wearing the elastic stocking for at least 14 days;
2. Patients under local anesthesia can walk after surgery; Patients under general anesthesia and epidural anesthesia are encouraged to walk after fully awake;
3. Ultrasound review 3-7 days after ablation;
4. Postoperative follow-up time is recommended by 1, 3, and 6 months.