Vein ablation is used to treat varicose veins associated with superficial venous incompetence. Usually, it is used to treat valve dysfunction in the greater or lesser saphenous vein. It is a minimally invasive technique that has replaced vein stripping. Instead of removing the entire vein from the inner part of the leg (stripping), we shut off the vein from the inside using heat. Under ultrasound guidance, a thin catheter is inserted into the vein through a needle stick. The catheter is advanced through the vein. A solution is inserted around the vein to insulate it and to collapse the vein walls around the catheter. The catheter is then used to “cauterize” the vein closed using heat energy, as the catheter is pulled out of the vein. Sometimes, laser is used for vein ablation, but more typically, the heat source is radiofrequency energy. Once the vein is closed, the blood is diverted into the healthier veins in the leg, and more normal blood flow is achieved because there is less pooling of blood in the superficial veins. The treated vein scars close, and over time become obliterated.
Vein ablation can be performed as an in-office procedure under a local anesthetic. Sometimes this procedure is combined with a minor surgical procedure that involves removing clusters of larger varicosities through small (½ cm) incisions or tying off (ligating) other feeding veins called perforators. In this case, the surgery is typically performed in an outpatient surgery center under a light general anesthetic or “twilight anesthetic.” Most often, we treat one leg at a time. Surgery takes 20 to 90 minutes, depending on the number of large varicosities being treated.
After surgery, you will not be able to drive yourself home. You will have an elastic bandage on the leg, extending from the foot to the groin. It needs to stay on and dry for two days. If it feels too tight or too loose, you can re-wrap it. There is no bed rest after surgery, and no need for crutches or a cane. You are encouraged to get back to your regular activities as soon as possible. Driving is permitted after 24 hours, as long as you are not taking pain medication. Most people will take pain medication only for a day or two after surgery; for many, acetaminophen or ibuprofen is adequate. People who work typically return to work in two to three days. A feeling of fullness, bruising, or soreness over the treated area is typical; sharp pain is uncommon. Cool compresses and walking exercise can help. The second or third week following the procedure, it is common to feel a tightness or “rubber band sensation” in the inner thigh as scar tissue forms around the treated vein. This is a normal part of the healing process and may last a few weeks to months. Gentle massage and stretching are encouraged. Many patients also feel that rubbing arnica cream into the area also helps.
A few days after surgery, we perform a repeat ultrasound to ensure that the treated vein is successfully closed. A week or so later, we see you again to check the wounds and discuss sclerotherapy, if you want to pursue this.
The risks of surgery are low (less than one to two percent). Occasionally, we see wound healing problems, minor infection, or a small clot under the skin surface. The risk of deep venous thrombosis (DVT) is less than one percent (similar to the risk of DVT if you had a cast on your leg).