Vein Procedures

Radiofrequency Ablation (RFA) Treatment for Varicose Veins

Radiofrequency ablation (RFA) is a procedure to treat varicose veins. It uses heat created from radiofrequency (RF).

Varicose veins are swollen, enlarged veins. They happen most often in the legs. Varicose veins can develop when valves in your veins become damaged. This causes problems with blood flow. Over time, too much blood collects in your veins. The veins may bulge, twist, and stand out under your skin. They can also cause symptoms such as aching, cramping, or swelling in your legs.

During RFA treatment, RF heat is sent into your vein through a thin, flexible tube (catheter). This closes off blood flow in the main problem vein.

The day of your treatment

The treatment takes 45 to 60 minutes. The entire treatment (including time to prepare and recover) takes about 1 to 3 hours. You can go home the same day. For the treatment: 

  • You’ll lie down on a hospital bed.
  • An imaging method, such as ultrasound, is used to guide the procedure.
  • The leg to be treated is injected with numbing medicine.
  • Once your leg is numb, a needle makes a small hole (puncture) in the vein to be treated.
  • The catheter with the RF heat source is inserted into your vein.
  • More numbing medicine may be injected around your vein.
  • Once the catheter is in the right position, it is then slowly drawn backward. As the catheter sends out heat, the vein is closed off.
  • In some cases, other side branch varicose veins may be removed or tied off through a few small cuts (incisions).
  • When the treatment is done, the catheter is removed. Pressure is applied to the insertion site to stop any bleeding. An elastic compression stocking or a bandage may then be put on your leg.

Recovering at home

Once at home, follow all the instructions you’ve been given. Be sure to:

  • Take all medicines as directed
  • Care for the catheter insertion site as directed
  • Check for signs of infection at the catheter insertion site (see below)
  • Wear elastic stockings or bandages as directed
  • Keep your legs raised (elevated) as directed
  • Walk a few times a day
  • Avoid heavy exercise, lifting, and standing for long periods as advised
  • Avoid air travel, hot baths, saunas, or whirlpools as advised

 

Sclerotherapy

Sclerotherapy is a form of treatment where a doctor injects medicine into blood vessels or lymph vessels that causes them to shrink. It is commonly used to treat varicose veins or so-called spider veins.

The procedure is non-surgical, requiring only an injection. It can also be used to treat blood and lymph vessel disorders that cause these vessels to form incorrectly.

Sclerotherapy uses an irritating solution called a sclerosant, which is injected directly into a vein or lymph vessel. The solution irritates the vessel, causing it to swell. This swelling cuts off the flow of blood or lymphatic fluid and the vessel shrinks.

Risks of Sclerotherapy

Sclerotherapy is a safe procedure. It is a less invasive and risky option than surgery, as it does not require anesthesia.

Research suggests that it effectively removes spider veins in 75–90 percent of cases, but typically requires multiple treatments. When sclerotherapy does not work, additional treatments, including surgery, may be needed.

The most common negative reactions to sclerotherapy include bruising, redness, and pain near the injected vein. About a third of people develop small branches of blood vessels surrounding the injected vein. These vessels usually disappear on their own.

Less frequently, an individual may experience allergic reactions to the solution, burning in the vein, and changes to skin color.

Tiny air bubbles from the needle can also get into the bloodstream, causing changes in vision, headache, and nausea.

Very rarely, a blood clot can form in the treated vein. Blood clots can travel to areas of the body and become life-threatening if left untreated. If a blood clot moves, it can cause an embolism.

People should seek emergency treatment if they experience chest pain, difficulty breathing, or dizziness after having sclerotherapy.

 

VenaSeal Vein Glue

The most recent innovation in the treatment of varicose veins is the use of medical glue known as VenaSeal (cyanoacrylate) to physically shut down and seal the main defective vein.

VenaSeal Adhesive (Glue), previously known as Sapheon Glue medical grade glue that is used to shut the main saphenous vein in the thigh. Once the vein has been glued shut, it will undergo a process of hardening (sclerosis) and will be gradually absorbed by the body. The procedure is minimally invasive.

How does VenaSeal work?

The VenaSeal procedure involves the placement of a very small amount of VenaSeal vein glue into the vein through a small catheter. Once the affected vein is closed, blood is immediately re-routed through other healthy veins in the leg. Unlike other treatments, VenaSeal does not require a regional nerve block or large volumes of anesthesia.

Furthermore, there are no pre-procedures drugs involved and patients can return to their normal activities right after the treatment. Unlike heat-based procedures such as endovenous laser or radiofrequency ablation, with VenaSeal there is no risk of skin burns or nerve damage. VenaSeal does not require any immediate post-treatment pain medication or uncomfortable compression stockings.

How effective is the VenaSeal procedure?

The published success of the VenaSeal closure procedure is up to 98.9% (VeClose study), with far fewer complications than EVLA or surgery.

VenaSeal has been meticulously trialed in the United States and Europe over the last 5 years. Results published show a low risk of complications and excellent medium-term results. The VeClose study out of Germany, showed a 98.9% closure rate at 6 months. VenaSeal is considered as effective as endovenous laser ablation but does not involve the use of heat and can therefore be performed with the application of a small amount of local anaesthetic as opposed to a nerve block or large volumes of tumescent anaesthetic.

It is possible to treat two or more veins in the one session. Stockings are usually not necessary and patients are able to return to normal activities immediately. Surface varicose veins are usually treated 2-4 weeks after the VenaSeal procedure with either ultrasound guided sclerotherapy or ambulatory phlebectomy.

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Ibrahim Eid, MD, FACS

Ibrahim Eid, MD, FACS

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