What is it?
Endovascular venous ablation is a procedure to close off varicose veins. It is an image-guided (ultrasound), minimally invasive treatment. It uses radiofrequency energy to cauterize (burn) and close the abnormal veins that lead to varicose veins.
‘Endovascular’ means that the procedure is done inside the blood vessel. ‘Ablation’ means to damage and close off the vein.
Varicose veins are twisted, enlarged veins near the surface of the skin.
The procedure seals off the main underlying faulty vein that is feeding the varicosities. This will either be the Great Saphenous Vein (GSV) in the thigh or the Short Saphenous Vein (SSV) behind the knee and calf. The traditional operation was to tie and strip these veins surgically. These minimally invasive ablation techniques have replaced surgery and are less painful with quicker recovery.
The procedure removes the LSV and SSV from the circulation without a wound and without stripping. The treatments can be performed under local anesthesia.
How is it done?
The procedure is done in the doctor's office. The procedure takes less than 1 hour.
Local anesthesia is used with a very thin needle on the leg.
A catheter is passed up the vein, from the ankle or knee level. It is carefully placed at the junction between the LSV/SSV and the deeper veins. An ultrasound scan is used to place the catheter precisely.
When the catheter is activated in contact with the vein wall an electrical current energy is passed through the vein wall. This causes the proteins in the vein wall to change shape and contract down. The catheter is slowly pulled back down the vein. This leaves the vein contracted down and no blood flows through it. The vein is effectively removed from the circulation achieving the same outcome that stripping of the vein does in traditional surgery. Long term follow up has shown that the veins largely remain closed off and rarely open up again.
After Care
After the procedure the doctor may wrap the leg with bandage. This will be replaced with a compression stocking, which is worn for 5-7 days. For the first few days it may be easier to wear the stocking day and night. After this, if the leg is comfortable without it at night, the stocking can be worn just during the day.
During the first week, the goal should be to stay active with walking and elevating the legs when resting. Standing for long period of time and crossing legs should be avoided.
After the ablation procedure, there may be some soreness in the legs. Anti-inflammatory pain killers will help with the discomfort.
Complications
Recovery is usually in 2-4 days.
In less than 10% of patients, small nerves next to the veins can be disturbed, leading to patches of numbness in the lower leg and foot. This resolves gradually but is sometimes permanent.
In less than 1% of patients, a rare side effect of clot in the deep vein (DVT) can occur. Keeping mobile after the procedure and wearing stockings help reduce the risk of this complication.
Infections in the very small wounds are uncommon.