Varicose Vein Ablation
Endovenous ablation is a minimally invasive treatment that uses
heat to cauterize or burn and seal off enlarged veins in the legs,
a condition called varicose veins. Normally, blood circulates from
the heart to the legs and back again using a system of one-way valves
to prevent the blood from flowing backward into the legs. When leg
veins become less elastic and valves malfunction, some blood may
remain in the leg where it pools and causes the vessels to become
enlarged or varicose.
Endovenous ablation is an image-guided procedure that uses heat generated by
radiofrequency energy or a laser to seal off the flow of blood to these faulty
vessels, diverting blood flow to nearby healthy veins.
What are some common uses of the procedure?
Although this procedure may be used for cosmetic purposes, it is
more commonly used to help treat symptoms. Symptoms are typically
due to enlarged nonfunctional veins that cause circulatory problems
- leg pain
- skin irritation, sores (ulcers) and discoloration
- inflammation of the veins (phlebitis), resulting in painful veins
How should I prepare?
You should report to your doctor all medications that you are taking,
including herbal supplements, and if you have any allergies, especially
to anesthesia or to contrast materials (also known as "dye" or "x-ray
dye"). Your physician may advise you to stop taking aspirin
or a blood thinner for a specified period of time days before your
You should wear comfortable, loose-fitting clothing. You will need
to remove all clothing and jewelry in the area to be examined.
You should plan to have a relative or friend drive you home after
You may be asked to wear a gown during the procedure.
What does the equipment
In this procedure, ultrasound, a catheter, a laser or radiofrequency
electrodes and a generator are used.
Ultrasound scanners consist of a console containing a computer and
electronics, a video display screen and a transducer that is used
to scan the body and veins. The transducer is a small hand-held device
that resembles a microphone, attached to the scanner by a cord. The
transducer sends out high frequency sound waves and then listens
for the returning echo. The principles are similar to sonar used
by boats and submarines.
The ultrasound image is immediately visible on a nearby screen that
looks much like a computer or television monitor. The image is created
based on the amplitude (strength), frequency and time it takes for
the sound signal to return from the patient to the transducer.
A catheter is a long, thin plastic tube, about as thick as a strand
Laser fiber and radiofrequency electrodes are fine wires that carry
electrical energy from the power generator.
How does the procedure work?
Using an ultrasound to visualize the enlarged vein, a catheter is
inserted through the skin into a blood vessel and positioned within
the abnormal vein. A laser fiber or radiofrequency electrodes are
then inserted through the catheter and advanced to the site. Heat
generated by the laser or radiofrequency energy is then applied,
heating the vessel and causing it to close. Following the procedure,
the faulty vein will shrink and "scar down."
How is it performed?
- Image-guided, minimally invasive procedures such as endovenous
ablation are performed by a specially trained interventional radiologist.
- This procedure is often done on an outpatient basis.
- Your physician may use a topical anesthetic cream over the abnormal
vein area before the procedure in order to reduce discomfort.
- Your physician will numb the area where the catheter will enter
into the abnormal vein with a local anesthetic and use the ultrasound
transducer or wand to study the vein and track its path.
- The leg being treated will be shaved, sterilized and covered
with a surgical drape.
- A very small nick is made in the skin at the site.
- Using ultrasound guidance, the catheter is then inserted through
the skin into the vein and positioned within the abnormal vein.
The laser fiber or radiofrequency electrode is then inserted through
the catheter. The tip of the fiber or electrode is exposed by pulling
the catheter back slightly.
- Local anesthetic is injected around the abnormal vein with ultrasound
guidance. Heat is then applied as the catheter is slowly withdrawn.
- Pressure will be applied to stop any bleeding and the opening
in the skin is covered with a bandage. No sutures are needed.
- This procedure is usually completed within an hour.
What will I experience
during the procedure?
- You may be asked to wear protective glasses if and when lasers
are in use.
- An area of your leg will be cleaned, shaved and numbed.
- You will feel a slight pin prick when the local anesthetic is
- The area will become numb within a short time.
- You may feel slight pressure when the catheter is inserted but
no serious discomfort.
- Injection of local anesthetic around the abnormal vein is the
most bothersome part of the procedure, because it usually requires
multiple injections along the vein. Actual closure of the vein
with laser or radiofrequency is usually not painful.
- Following the procedure, you will need to wear a compression
stocking to help reduce bruising, tenderness, and the small possibility
that blood clots may form.
- You may resume your normal activity immediately, with the exception
of lifting heavy objects or prolonged sitting (such as 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.
Who interprets the results and how do I get them?
A follow up ultrasound examination is essential in order to assess
the treated vein and also to rule out potential complications.
In most practices, the first ultrasound exam is needed in 24-48
hours after the treatment and the second exam six weeks later.
The main vein should be completely closed at this point. Additional
procedures (such as sclerotherapy or phlebectomy) may be necessary
to treat associated veins.
What are the benefits vs. risks?
- No surgical incision is needed—only a small nick in the
skin that does not have to be stitched closed.
- 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.
- Ablation is generally complication-free and safe.
- This procedure leaves virtually no scars because catheter placement
requires skin openings of only a few millimeters, not large incisions.
- Endovenous ablation offers a less invasive alternative to standard
- Most of the veins treated are effectively invisible even to ultrasound
24 months after the procedure.
- Most patients have immediate symptom relief and are able to return
to normal activities within a day or two, with little or no pain.
- Any procedure where the skin is penetrated carries a risk of
infection. The chance of infection requiring antibiotic treatment
appears to be less than one in 1,000.
- Any procedure that involves placement of a catheter inside a
blood vessel carries certain risks. These risks include damage
to the blood vessel, bruising or bleeding at the puncture site,
- Some postoperative bruising and tenderness may occur, but may
be alleviated by wearing a compression stocking.
- Some instances of thermal (heat) damage to nerves have been reported.
This is rare and generally goes away in a short time.
- Thrombophlebitis (inflammation of the vein) is not uncommon (may
cause pain and redness over the treated area), but generally responds
well to nonsteroidial anti-inflammatory drugs (NSAIDs). Blood clots
that formed in the veins can travel to the lungs (pulmonary embolism);
however, this is an extremely rare occurrence.
What are the limitations of Endovenous Ablation of Varicose Veins?
Ablation catheters cannot be easily passed through a
tortuous vein, or a vessel with many turns and bends. 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.
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 the injection of a liquid agent to seal them off, called
sclerotherapy. Subsequent treatments are usually scheduled after
an ablation procedure.