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Radiofrequency Ablation for Varicose Veins

Minimally-Invasive Endovenous Treatment

 

Radiofrequency ablation (RFA) is a walk-in/walk-out procedure for the treatment of varicose veins. It is as effective as open surgery, but can be done with no surgical incisions and minimal post-operative discomfort.

RFA is suitable to treat the main superficial veins in the thigh (long saphenous vein &/or anterior accessory saphenous vein) or calf (short saphenous vein). It is not suitable for spider veins (telangiectases), which are treated using micro-sclerotherapy (see microsclerotherapy).

Most patients with varicose veins are suitable for the technique.

The treatment cannot be performed during pregnancy.

 

  

 

Advantages of RFA over Open Surgery:

 

Walk-in, walk-out procedure
Local anaesthetic (with or without sedation)
Short procedure time (~30 - 60 mins)
Minimal post-operative discomfort
No scarring from surgical incisions

 

Preparing for the Procedure:

 

During your initial consultation, you will be fitted with a class II compression stocking to wear following the procedure. The stocking must be brought with you on the day of treatment.

Warm clothes should be worn on the day of the procedure to help dilate the veins. A tracksuit is ideal, as the loose-fitting tracksuit pants can be easily worn over the compression stocking following treatment.

The procedure is done under local anaesthetic, most often with some sedative medication. If the procedure is done in the operating suite, occassionally a general anaesthetic is used. 

As you will receive sedative medication, you will need someone to drive you to and from the hospital for treatment.

 

Description of the Procedure:

 

The procedure is performed under ultrasound guidance. A small nick is made in the skin (usually on the inside of the leg at knee level) to introduce a sheath in to the main incompetent vein. The radiofrequency probe is fed through the sheath and positioned at the top of the vein (usually at groin level). A cold solution of saline (containing some local anaesthetic and adrenaline) is injected around the entire length of the vein to cause it to spasm down around the probe, numb the area, and protect surrounding structures. The entire length of the defective vein is then 'ablated' by heating the probe on the inside of the vein, causing it to shut down. The varicose veins which stem from the ablated vein are then injected with a sclerosant under ultrasound-guidance (see ultrasound-guided sclerotherapy). This irritates the veins, causing them to spasm down and block off. If there are large varicose veins, Mr Milne may elect to remove these via several small nicks in the skin (phlebectomies). Note: phlebectomies are only performed if the procedure is done the hospital operating suite.

If the procedure is performed in the hospital operating suite (with an anaesthetist), sedative medication is used. You will therefore most likely be unaware of the procedure taking place. If the procedure is performed in the office-based procedure room (no anaesthetist), you will be awake. You will therefore feel some stinging discomfort associated with the local anaesthetic injections and sclerotherapy. If you wish, a mild sedative tablet can be taken 30 minutes prior to the procedure, but this is normally not required.

Note: About 2% of patients require a small incision in either the groin crease or knee crease at the same time as radiofrequency ablation. This is called 'hybrid' treatment. This is done to tie off the origin of the main incompetent vein if the diameter of the vein is too large for ablation alone. 

 

Following the Procedure:

 

At the end of the procedure, a small, clear adhesive dressings is applied to the skin over the nick (usually on the inside of the knee), and a compression stocking applied to the whole leg. If phlebectomies are performed, steristrips and more clear adhesive dressings will be applied to the skin, and sometimes an additional compression wrap over the stocking.

You will be asked to walk for 20 minutes following the procedure before returning home. This clears the deep veins of any residual sclerosant, minimizing the risk of deep vein thrombosis (DVT).

It is important to walk regularly in the days following the procedure. Avoid standing still for prolonged periods. When not mobilising, you can rest with your legs up. The majority of patients can resume regular activities the next day, but should hold off on any heavy leg exercises (e.g. running, cycling, gym exercise classes) for at least 7 days. If your work involves prolonged periods of standing or significant physical activity, it may be advised to take a short period of time off work. For guidance, please discuss your circumstances with Mr Milne.

Note: If a groin crease or knee crease incision was performed during your treatment (~2% of patients), your recovery will be a little slower. It is still important to walk regularly in the days following the procedure, but you should plan for a few quiet days and take 72 hours off work following the procedure. After 2 weeks, you will be able to gradually re-introduced leg exercises, working back up to full exercise capacity by 3 - 4 weeks.

A follow up ultrasound will be done at 24 - 48 hours after treatment to check the ablated vein and ensure there is no DVT.

The compression stocking should be worn full-time for the first 48 hours. After this, it can be taken down for showering, but otherwise it is ideal to wear full-time for the first week. If it is uncomfortable to sleep in, it can be removed at night when in bed. After the first week, the stocking can be worn for an additional week during the day for comfort if desired.

When showering, it is best to keep the water luke-warm during the first few days. On day 5 after the procedure, the small, clear adhesive dressings (in addition to any steri-strips if used) can be peeled off in the shower.

If you are planning travel soon after your procedure, please discuss this with Mr Milne. As a rule of thumb, it is best not to travel for the first week following the procedure. After that, it is ideal to avoid plane/train/car travel over 4 hours duration until 4 weeks following the procedure. It is important to wear your compression stockings, stay hydrated, and walk around the cabin regularly whenever flying. 

For general queries after the procedure, please contact the office and we will be happy to answer any questions.

You will be scheduled for a review appointment with Mr Milne after 4 - 6 weeks.

Radiofrequency ablation effectively shuts down the main defective vein in >99.5% of cases. Sclerotherapy is less definitive, as the varicose veins which stem from the ablated vein are numerous. It is common to see some residual varices which require some additional injections in the post-operative period to complete the treatment. This is termed 'top-up' ultrasound-guided sclerotherapy (see ultrasound-guided sclerotherapy).

 

Please Note:

- Occassionally, a discomfort is felt along the length of the ablated vein. It is often described as a 'pulling' sensation. This usually somewhere between days 5 - 14, and is associated with inflammation of the treated vein. The discomfort settles on its own. To help it settle, it is recommended that you apply voltaren gel, wear your compression stocking, and take regular paracetamol.

- It is expected that the varicose veins become hard and lumpy under the skin following sclerotherapy. This is a good sign, as it indicates that the veins have blocked following treatment. The lumpy veins usually become a bit tender to push on around day 5, and this can last a few weeks. This is another good sign, as it is associated with the inflammation that occurs in a successfully treated vein.  It is rare to need anything more than panadol for this. Topical voltaren gel can be used to help things settle. You will notice the lumps gradually shrink down and disappear over the months following the procedure.

- If you experience any major leg pain or swelling, or any chest pain or shortness of breath, this should be investigated urgently. If it is after-hours, Mr Milne can be contacted via the paging service.

 

Summary of Potential Issues Following the Procedure:

 

Discomfort/tenderness/bruising:

  • It is normal to expect some discomfort and bruising overlying the treated veins. It is expected that they will be tender to push on.
  • This is related to the procedure itself, but also the inflammatory process which consumes the vein over the weeks to months following the procedure.
  • Usually no pain relief is required, but panadol and topical voltaren gel can be used.
  • It is important to stay active during this time.
Bleeding:
  • Some ooze can occur in the first few hours following treatment.
  • This is not dangerous. It is usually stopped by applying 10 minutes of compression over the site of ooze and resting with the legs up for 20 minutes.
  • If persistent, you should contact the office and we will arrange for a second layer of bandaging to be applied.
Pigmentation:
  • Light-brown pigmentation occurs in about 25% of cases along the course of treated veins.
  • This is related to the sclerosant itself, and the iron component of blood being absorbed by the skin.
  • This usually fades slowly over time (usually within 6 months). It is rare to persist beyond 12 months.
Deep vein thrombosis (DVT):
  • Major DVT is rare (<0.5% of cases).
  • If this occurs, a course of oral anticoagulation is usually prescribed with a follow up ultrasound.
Very rare complications (<0.5% of cases):
  • Infection
  • Ulceration
  • Allergic reaction/anaphylaxis
  • Nerve injury
Recurrent veins (in the years following the procedure)
  • Recurrent varicose veins occur in ~20% of patients in the 5 years following treatment for varicose veins
  • If this occurs, a repeat ultrasound scan can be performed to determine the nature of recurrence and best treatment option

Main Consulting Rooms

Suite 37, Cabrini Medical Centre,
183 Wattletree Rd,
Malvern VIC 3144


For all enquiries...
Please contact the office between
8:30am to 4:30pm, Monday to Friday


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