Introduction
Endovenous Ablation therapy is used to treat the underlying abnormal vein that causes Varicose Veins. Varicose veins are caused by a failure or leaking of the normal one-way valves that are present in all of the leg veins. Once the valves become leaky (incompetent) blood flows down toward the feet, increasing the pressure in the vein and allowing varicose veins to develop.
The 2 common veins that cause Varicose veins are:
- Long (Great) Saphenous vein – runs from the ankle up the inside of the leg to the groin region to join the deep veins.
- Short Saphenous Vein – runs from behind the ankle up to behind the knee where it joins the deep leg veins.
Once the valves inside of these veins fail, then stopping the abnormal blood flow is critical to treating the varicose veins.
Endovenous Ablation therapy uses Heat (laser or radio-frequency source) to damage the vein causing it to shrivel up and importantly stops the abnormal blood flow. The vein itself is not removed but will gradually shrivel away and disappear.
Indications
Varicose vein treatment depends on many factors. The symptoms that may occur include:
- Pain.
- Bleeding.
- Unsightly large veins.
- Skin damage.
- Ulcers.
- Clotting.
If the underlying cause is found to be the long or short saphenous vein then stopping the abnormal blood flow is the aim of treatment. Ablation therapy is the easiest and most effective treatment.
Preoperative Instructions
Most varicose vein procedures are performed as day surgery usually under a light General Anaesthetic. Review of medications, particularly blood thinners and diabetic medications will occur when surgery is booked.
A prescription for fitted compression stockings will be provided and it is worth trying these stockings on a few times prior to the surgery.
Fasting times will be provided at the time of booking. On the day of surgery, the visible varicose veins will be marked with the patient standing, prior to the commencement of surgery.
Procedure
Ultrasound is used to identify the abnormal veins and guide the placement of the ablation catheter. The ablation is performed by a catheter (tube) that is positioned inside of the vein. It heats the vein from the inside which damages the vein itself, causing it to shrivel up.
A small puncture is performed in the lower leg to gain access into the relevant vein. Local anaesthetic is injected around the vein to help collapse the vein onto the catheter and ensure even heat distribution. The catheter is then used to treat the entire length of the vein.
Following the ablation, any visible veins that have been pre-marked will be removed through small 2-3 mm incisions. The ablation then deals with the underlying abnormal vein and then the larger veins are physically removed. No sutures are required and steristrips (tapes) are used over the small incisions.
A compression bandage is then applied to the leg from foot to groin. The bandage will help control bruising and swelling and reduce inflammation.
Postoperative Instructions
NB: These are general guidelines and may not apply to your specific case.
Post-operative
Bandaging is removed the day after your surgery. You will find that your leg has 2 bandages: a padded absorbent layer or combine and a layer of Vaseline gauze. These layers can all be removed. Over the small incisions, you will find either brown or white tapes or Steristrips. These should be left on for as long as possible (usually 7 days) and then gently peeled off in the shower. Once the dressings have been removed, then you may have a shower and wash the leg. After your shower, you need to apply your thigh length compression stocking. You should wear the stocking for the next 2 weeks. The first week should be 24 hours per day, and then just during the day for the second week. The stocking can be removed each day for you to shower and can be left off for an hour or so to wash and dry the stocking as required.
Wound Care
It is normal to have some bruising around the incisions and occasionally some areas of hardness will develop under the skin. This is a normal part of the post-operative process and is not a concern. Leave the Steri-strips over the wounds until they start to come off themselves then gently peel off in the shower.
Medications
Simple Panadol or Nurofen is generally all that is required following the vein surgery. If pain is not controlled with these medications then please contact Dr Boyne.
Activity
It is important to return to normal mobility as soon as possible. Ideally, you should walk for 30 minutes per day. When not walking, it is best to elevate the legs to prevent swelling. This is most important in the first week after your surgery. A gradual return to all of your usual activities should occur by 2 weeks following your surgery. It is best to avoid prolonged standing or vigorous exercise (such as running) until after 2 weeks. Driving your car should be avoided for the first few days following your surgery but can be resumed once you are comfortable that you can press on the pedals safely.
Follow-up
If you have pain that is not controlled by simple analgesics or you have marked leg swelling it is important to contact Dr Boyne. Otherwise, a review appointment will be scheduled for 2 weeks after your surgery. It is best to avoid plane travel for at least one month after surgery if possible.
Risks
Varicose vein ablation therapy is very safe however a few small complications can occur.
Potential complications include:
- Bleeding – it is normal to get a degree of bruising form varicose vein treatments. This will gradually resolve over 5-7 days but in some patients can last up to 2 weeks.
- Infection.
- Haematoma – a haematoma is a collection of blood in the tissues, essentially a large bruise. They can become quite inflamed after vein surgery and form a red, tender hard lump. They will gradually resolve over 2-3 weeks and can be treated with anti-inflammatories.
- Deep vein thrombosis (DVT) – a rare event following vein surgery, and the likelihood is reduced by use of the stockings, regular walking and leg elevation. It is normal to have some leg swelling after vein surgery, but if this is excessive and the whole leg is painful then screening for a DVT should occur.
- Nerve Injury – there are sensory nerves close to the major veins in the leg. They can be irritated from the surgery and can cause some numbness or altered sensation in the lower leg region. This usually recovers over 2-3 months but in rare situations can cause some permanent sensory change.
- Varicose Vein Recurrence – the ablation treatment is the most successful way of preventing varicose veins recurring. There are many veins in the leg however, that can also develop similar valve issues and can cause more veins to occur. Often these can be dealt with by simple injections however some people develop new large veins that require further surgical treatment. Regular walking and avoiding standing still for long periods may help reduce the risk of recurrence.
Treatment Alternatives
There are a number of ways to treat varicose veins. The particular choice often depends on the nature of the veins and the presence of underlying valve abnormalities. Generally, ablation therapy is considered the gold standard treatment for major valve incompetence.
Other treatment options include:
- Compression stockings – stockings will help control some of the symptoms of Varicose Veins but can be difficult to wear at all times but are useful in patients who cannot have, or prefer to avoid, surgery.
- Sclerotherapy – injection treatment of varicose veins is very useful for isolated or surface, spider veins. It is best to deal with any underlying major venous incompetence with ablation therapy, and then use sclerosant injections as supplementary treatment if required.
- Varicose Vein Stripping – the surgical removal of the abnormal incompetent veins is used to treat very large veins that are not suitable for ablation therapy.
- Glue – varicose veins can be glued closed in certain circumstances. This is an evolving technique that is useful for some varicosities but has not replaced ablation therapy as the standard treatment for most patients.
Related Information
Sclerotherapy
Vein Stripping
Spider and Reticular Veins
Varicose Veins
Superficial Thrombosis
Venous Ulcers