Endovenous Thermal Ablation for Treating Varicose Veins

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What is Endovenous Thermal Ablation?

Endovenous thermal ablation is a procedure where controlled heat is used to seal varicose veins.

More specifically, it is used to treat abnormal “saphenous veins”, which are the underlying cause of most cases of varicose veins.  The saphenous veins are long, straight veins that course up the inside and back of the leg.  When the valves in these veins start to fail, the blood is able to flow in the wrong direction back down then leg.  This causes the pressure to build up, and leads to a chain reaction where other valves further down the leg start to fail as well.  When this process of damage spreads to the veins that travel close to the skin, the veins dilate and elongate, causing visible varicose veins.  These visible veins are therefore usually just the tip of the iceburg of what is actually happening inside the leg.

Treating abnormal “incompetent” saphenous veins is therefore a very important first step to ensure successful, durable results when treating varicose veins.

The traditional method of treating sapheneous veins was “stripping”.  This involved an incision at the groin to disconnect the saphenous vein from the deeper veins.  A wire or plastic “stripper” is then passed down the inside of the vein and a second incision is performed over the vein further down the leg.  The vein is tied to the stripper, and pulled out of the leg.

This method has now been superseded by endovenous thermal ablation.  The first version of the endovenous thermal ablation procedure used a laser to apply the heat, and is often referred to as endovenous laser ablation (“EVLA”), or simply “laser”.

Another more recent method of heating the vein is with radiofrequency energy, which is known as “radiofrequency ablation”  or “RFA”.  This heats the vein in a more gentle and even fashion than laser, which leads to even less pain and bruising, yet with the same success rates.

An alternative method of treating abnormal saphenous veins is with VenaSeal “glue”.

Diagram showing the process of closing a vein via thermal ablation.

How is Endovenous Thermal Ablation done?

The procedure is performed through a tiny nick in the skin.  It is too small to even stitch!  Ultrasound is used to guide a needle into the abnormal vein, and a special catheter is then threaded up the inside of the vein to where it joins the deep veins. A very dilute local anaesthetic solution is then injected around the vein. This compresses the vein against the catheter and protects the adjacent normal tissue. The catheter then heats the vein as it is withdrawn, which damages the wall of the vein causing it to seal.  A healing process then occurs over several months, with the final result being permanent sealing of the vein.

After the abnormal saphenous veins have been treated, the visible varicose veins can then be addressed.  This can either be done with phlebectomies, where the veins are removed with a small hook through a tiny nick in the skin, or with sclerotherapy, where the veins are injected with a medication to seal them, or a combination of both.  Phlebectomies can be performed at the same time as endovenous thermal ablation, enabling a one step treatment of all of the larger varicose veins.  Sclerotherapy is usually done as a second step, and can be used to treat spider veins as well.

What are the advantages of Endovenous Thermal Ablation?

Endovenous ablation is much less invasive, yet more thorough than traditional stripping.  This means:

  • Less pain and bruising
  • Faster recovery
  • Less time off work
  • Lower risk of complications
  • Less scarring
  • Lower chance of recurrence

Does Endovenous Thermal Ablation hurt?

The local anaesthetic injections are the most uncomfortable part of the thermal ablation procedure.  Whilst most people tolerate these injections quite well, Sunshine Coast Vascular is commited to ensuring you are as comfortable as possible during the procedure. Don’t want to know about it? No problem.  We offer a choice of local anaesthetic only, “twilight” sedation, or even a light general anaesthetic if you prefer.  If you would like to a have a single step treatment with simultaneous phlebectomies, then a general anaesthetic is usually required.

Are there side effects to Endovenous Thermal Ablation?

Serious complications following endovenous thermal ablation are uncommon, however all procedures have risks, and these need to be carefully weighed up against the risks and benefits of all options, including not having any invasive treatment.

Risks include:

  • bruising
  • discomfort – there may be some discomfort in the treated vein for a period of time after the procedure, particularly early in the healing process.  The average pain relief needed after ablation is paracetamol for a few days, although this does vary quite a lot from person to person.
  • phlebitis – some of the varicose veins common off the treated saphenous vein may become lumpy and tender in the days after the procedure.  This is rarely serious and the discomfort usually improves within days, although the lumpiness can take weeks to fully resolve.
  • recurrence – over time new varicose veins may develop if previously normal veins start to become damaged. This is relatively common as people with varicose veins often have a tendency to develop them in the first place. If new varicose veins develop, then they can usually be treated if desired.
  • DVT – this is an extremely rare, but one of the more potentially serious complications of vein treatment (it is also a risk of untreated varicose veins!).  Sunshine Coast Vascular patients are provided with a list of precautions to follow before and after treatment sessions to minimise the chances of this occuring.  This includes regular walking and avoiding long-haul flights close to treatments.  The use of compression stockings during treatment is very important to help minimise the risk of DVT.

Am I suitable for Endovenous Thermal Ablation?

In order to determine what options may be appropriate for you, you will need a referral from your General Practitioner to arrange a consultation with Dr Magee at Sunshine Coast Vascular. Dr Rebecca Magee is an experienced vascular and endovascular surgeon on the Sunshine Coast, offering a full suite of treatment options for varicose veins. Dr Magee offers both “walk in, walk out” and day surgery treatment options. Contact us to request an appointment.

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