What is Endovenous Ablation of Varicose Veins?
For patients suffering from varicose veins, new techniques that treat the veins from the inside, called endovenous radiofrequency ablation (RFA) and laser ablation offer less invasive alternatives to standard surgery. Ablation procedures use heat energy from either radio waves or a laser source to seal the afflicted vein. Local anesthesia is all that is required, and patients often feel immediate relief. Interventional radiologists perform these procedures on an outpatient basis and when compared with traditional "vein stripping" techniques, endovenous ablation is more effective, has fewer negative outcomes, and is associated with much less pain during recovery. There are virtually no scars because catheter placement requires skin openings of only a few millimeters, not large incisions.

What are some common uses of the procedure?
Endovenous ablation offers a safe, effective and easy method of eliminating varicose veins, which can cause debilitating leg symptoms such as severe pain and skin ulceration. Normally, the veins in the leg return blood to the heart by the pumping action of the muscles when a person walks. One-way valves prevent reflux of blood back into the legs. As we age, our veins become less elastic and the valves can begin to malfunction. When this happens, the veins become distended and take on a ropy appearance that can be both unsightly and painful. The legs become swollen and ambulation is impaired. Endovenous ablation may provide a solution to the problem.

How should I prepare for the procedure?
No special preparation is necessary. However, you may be asked to wear protective glasses while lasers are in use. Patients who take blood thinners on a daily basis may be asked to stop their medication in advance of the procedure to minimize the risk of bruising and bleeding.

What does the equipment look like?
An external ultrasound wand is used to study the vein and track its path. It is also used to help guide the insertion of the catheter and gauge the effectiveness of the procedure. A small control box, or generator, is used to power the laser or the electrodes. The inside tip of the catheter varies depending on whether it houses a laser fiber or radiofrequency electrodes. On the outside, all one sees is the plastic sheath (a slightly larger type of catheter) through which the radiologist passes the treatment catheter.

How does the procedure work?
Unlike older, more invasive procedures that strip veins from the leg through the use of small incisions, endovenous ablation uses a catheter, or small tube, which is inserted through a small nick in the skin. Only local anesthesia is required.

How is the procedure performed?
At the start of the procedure, the skin is numbed and a small needle is inserted into the refluxing vein using ultrasound guidance. A thin catheter is then introduced to deliver the laser or radiofrequency energy. This heats and seals the vein closed. Blocking of a faulty vein does not adversely affect the venous circulation, because other veins assume responsibility for blood return back to the heart. The diseased vein shrinks and scars down after treatment. Successfully ablated veins are unlikely to reopen and cause later problems.

What will I experience during the procedure?
The leg being treated will be sterilized and covered with a surgical drape. A local anesthetic (usually xylocaine) will be administered to the site where the incision will be made, generally immediately above or below the knee. Let your doctor know if you have an allergy to anesthetics. By the time the heat energy is delivered, the vein should be numb and there should be no pain. The procedure starts by advancing the catheter inside the vein up to the top of the leg and then the energy is deposited as the catheter is slowly withdrawn. Throughout the procedure, the radiologist guides the catheter using the external ultrasound wand positioned directly outside on the surface of the leg. Endovenous ablation typically takes one hour. A compression stocking must be worn after the procedure to help reduce bruising, tenderness, and the slim possibility of forming blood clots. Normal activity can be immediately resumed, with the exception of lifting heavy objects or prolonged sitting (for instance a long plane or bus trip). You should not remain inactive or spend too much time in bed during the recovery period since this increases the chance for clotting complications. Endovenous ablation is successful at closing the main vein almost 100 percent of the time, but small dilated branches that persist in the skin often require additional treatment with phlebectomy (a minor surgical procedure to extract them) or injection of a liquid agent to seal them off, called sclerotherapy. Subsequent treatments can be scheduled two to four weeks after ablation.

Who interprets the results and how do I get them?
One to four weeks after endovenous ablation, the radiologist will follow up using ultrasound to ensure that the procedure was successful at treating the problem with the veins in the leg. The main vein should be completely closed at this point. Minor additional procedures to treat associated veins may be necessary.

What are the benefits vs. risks?

Benefits

Risks

What are the limitations of Endovenous Ablation of Varicose Veins?
Ablation catheters cannot be easily passed through a tortuous vein. Consequently, the procedure is typically used to treat larger varicose veins, such as the great saphenous vein, which extends from the groin down the inside of the thigh into the inner calf.