Patient Information: Varicose Vein Ablation Therapy
What to Expect on the Day of Your Vein Procedure
- Duration: You will be at the office for about 2 hours, though the procedure itself takes
only about 30 minutes. The extra time is for check-in, prepping, imaging, and bandaging. - Medication: You will be prescribed a relaxing medication the day before the
procedure—take it as directed. - Preparation: Shower and shave the operative leg the night before. Do not use lotions or
creams on your skin.
Transportation: You will need a ride to and from the office unless you choose not to
take sedatives, in which case you may drive yourself. - Bring: Bandages or compression stockings and take all your regular medications (unless
directed otherwise).
The Procedure
Ablation of Deeper Veins
- The procedure treats venous insufficiency by focusing on deeper veins, such as the Great Saphenous Vein and Small Saphenous Vein. These veins are located inside your muscles and are detected by ultrasound.
- Ablation (RFA or Laser) is used to treat these larger veins before addressing superficial spider veins. Not treating the deeper veins first can lead to recurrence of spider veins.
- Most insurance plans cover ablation procedures as they help reduce complications like blood clots and cellulitis, but they do not significantly improve cosmetic appearance unless the disease is caught early.
Cosmetic Treatment for Spider Veins and Varicose Veins
- Cosmetic treatments include:
- Laser sclerotherapy
- Chemical sclerotherapy
- Phlebectomy
- These cosmetic procedures are not covered by insurance as they focus on improving appearance rather than medical necessity.
How the Procedure Works
- The procedure is performed under sterile conditions with ultrasound guidance to locate the vein and position the catheter.
- Local anesthesia is applied, which may feel like a bee sting and slight burning.
- A catheter is inserted into the vein and advanced to the target area (near the groin or behind the knee).
- Anesthetic fluid is injected around the vein to numb the area and protect the surrounding tissues.
- The catheter delivers heat (RFA) or energy (laser) to collapse the vein, following the same technique regardless of whether RFA or laser is used.
- The treated vein shrinks and closes off, rerouting blood to healthier veins.
What to Expect After the Procedure
Post-Procedure Care
- Compression Stockings: Wear compression stockings continuously for 2 days, and then during waking hours for the next 2 weeks.
- Elevation: Elevate your leg whenever seated.
- Walking: Walk every hour for a few minutes and aim for a 20–30-minute walk daily if possible.
Post-Procedure Symptoms
- Pain: Mild to moderate discomfort may occur but typically responds well to ibuprofen. You may also feel tenderness or bruising where the anesthesia was administered.
- Bruising: Some discoloration or bruising may appear but typically resolves within 3-4 weeks.
- Swelling: Swelling, especially in the ankle, is common and usually resolves within a few days or weeks. Compression stockings and leg elevation help reduce swelling.
- Pulling/Tight Sensation: A pulling feeling may develop 1-3 weeks after the procedure as the treated area heals. This is normal and temporary.
- Skin Discoloration: Some patients may notice discoloration along the treated veins, which can last several months.
- Superficial Thrombophlebitis: You may feel a small cord under the skin with redness or warmth. If this occurs, call your doctor for treatment.
Restrictions After the Procedure
- Driving: Have someone drive you home on the day of the procedure. You can resume driving the day after.
- Activities: Light walking is encouraged but avoid heavy lifting or straining for 1 week.
- Bathing: Take sponge baths for the first day, then resume normal showers.
- Work: You can return to work the day after the procedure.
- Exercise: Avoid sports and strenuous activities for 1 week.
Flying: Avoid flying for 1 week, and wear compression stockings on flights longer than 4 hours.
VEIN ABLATION. LASER AND RFA TREATMENT OF VEIN DISEASE
Invasive procedural therapy for vein insufficiency has been proven to be safe and efficient. The following procedures are FDA approved in USA.
- Ablation with Laser or Radiofrequency – shrinking and collapsing the faulty vein, resulting in vein scaring
- Phlebectomy – removal of bulging varicosities
- Sclerotherapy – chemical destruction of the vein.
What is a vein ablation
Ablation means cauterizing with disappearance of large, deeper veins: Great saphenous veins and Small Saphenous
Ablation can be done using different types of energy and catheters, but the same technique. With RFA we use heat as radio wave energy, delivered by a catheter to cauterize (burn) the vein. With laser, multiple bursts of laser energy is delivered to the vein wall, shrinking and collapsing the vein. Laser fibers and radiofrequency electrodes are long thin wires that carry energy from power generators into the body.
Choosing one technique over another depends on your vein anatomy, size, tortuosity. Both techniques end in the same results.
- The large, deeper veins are located inside your muscle, not visible to you, and detected by ultrasound.
- These large veins should always be treated first, before the spider veins; not treating them first will lead to recurrence of the superficial, cosmetic, spider veins, in the same location or different ones.
How is a vein ablation performed
Ablations are performed under strict sterile conditions and under Ultrasound guidance. Your leg will be washed with sterile solution and covered with sterile surgical drapes.
Ultrasound imaging is used throughout the procedure locating the vein and the desired position of the catheter tip.
Sterile draping of the leg and ultrasound imaging
Local anesthesia is given at the point of entry into the vein, felt as a bee sting and burning sensation.
- The catheter (a tiny pipe) is inserted into the vein and advanced under Ultrasound guidance to the uppermost segment of the vein- the groin or behind the knee, depending which vein is treated
The ablation catheter
- Diluted anesthetic fluid is injected into the area surrounding the vein. This numbs the leg providing a layer of protection outside the vein.
Ultrasound image of the vein surrounded by diluted anesthetic fluid
- The vein is then treated by delivering energy through the catheter.
- Upon completion, the catheter is removed, pressure is applied to prevent any bleeding and the opening in the skin is covered with a bandage. No sutures are necessary. The leg is wrapped in ace bandages.
- This procedure is usually complete within 25 minutes
What to expect after the ablation?
- Wear the compression hose continuously for 2 days, then during all waking hours for 2 weeks.
- Elevate the treated leg whenever seated.
- Walk every hour for a few minutes. Also add a 20–30-minute walk daily if able. Walking is strongly encouraged.
- Ambulatory Phlebectomy: you can remove the Coban (disposable ace wrap) in the first 24 hours. Leave the support hose on continuously for the 2-day period then for 2 weeks during waking hours.
- Band-Aids, Tape, and Gauze: Remove the tape and gauze after 1 day.
- Take Ibuprofen 400 mg in am and 400 mg pm, for 5 days; this will decrease the normal inflammatory response and discomfort post procedure.
Post procedure symptoms
- Pain: may experience mild to moderate discomfort following the procedure. The leg may be tender to the touch after treatment; it is normal to experience some tenderness or bruising in the areas where local anesthesia was administered. This pain responds well to Ibuprofen
- Transient bruising: some patients may notice some mild bruising or discoloration after treatment. This discoloration is almost always transient and will resolve in about 3-4 weeks. In rare cases, this darkening of the skin may persist up to a year.
- Leg/Ankle Swelling: may occur especially after treating large varicose veins. It usually resolves in a few days but may last a few weeks. Wearing the prescribed compression hose and elevation will help lessen the swelling. If uncomfortable, a small dose of diuretic will be prescribed
- Some patients may experience a “pulling” or “tight” sensation 1-3 weeks after the procedure. This is the effect of the treated area healing. Occurs mainly when treated vein is close to the skin and there is minimal fat tissue around.
- Discoloration of the skin along the treated veins. This may last several months.
Superficial thrombophlebitis: You may feel a small cord under the skin, with redness and warm sensation. Call us and anti-inflammatory drugs such as ibuprofen, antibiotics, or even blood thinners may be prescribed for a short period of time
Restrictions after the procedure
- Driving: You need someone to drive you to and from the office on the day of the procedure, due to sedatives administered. Drive as tolerated after the first day.
- Activities: You should be walking hourly.
- Heavy Lifting Restrictions: No heavy lifting or straining for 1 week after the day of the procedure.
- Bathing: Sponge baths only for the first 1 day.
- Work: You may return to work next day after the procedure.
- Sports/Exercise: 1 week from the day of the procedure.
- Sexual Activity: Whenever comfortable.
- Diet: Resume normal diet.
Flying: Allowed 1 week after the procedure. We advise compression stockings for flight longer than 4 hours.
