Endovenous Ablation Therapy
What is this operation?
Endovenous ablation therapy is a group of minimally invasive, image-guided techniques that utilise thermal energy to close/seal the varicose veins. Circulation Clinic is able to offer endovenous laser ablation (EVLT) and radiofrequency ablation (RFA).
What happens before the operation?
Before you undergo endovenous ablation a number of investigations and assessments will have been performed. Once the decision has been made to proceed to endovenous ablation further investigations may be required to assess your overall fitness. These may include: •Blood tests •ECG Once the decision has been made to proceed to surgery an admission date will be agreed between you and your surgeon. A pre-admission visit may be required to complete paperwork and undertake blood tests or other allied tests. Please bring all your medications to your pre-admission review.
What happens on the day of the procedure?
These procedures are carried out as day-cases. You will be told the time to arrive for your procedure. The consultant will check with you that you fully understand what you are undertaking and ask if you have any additional queries or questions. You will be asked to stand and the consultant will mark your veins with a marker pen or use a USS to confirm their location. Please do not stop any of your normal medications unless specifically instructed to by your surgeon. If you smoke we strongly encourage you to stop as soon as possible to reduce the risk of peri-operative complications.
What happens during the procedure?
The procedure is usually performed under a local anaesthetic. Initially you will undergo an ultrasound scan to look at the veins again and check before surgery that nothing has changed. Your consultant will numb your skin with a local anaesthetic injection over the vein before making a small 2mm cut over the vein low down the leg. Using ultrasound image guidance, a narrow tube called a catheter is put into the vein that requires treatment (see figure 1). Local anaesthetic and a cooling fluid are injected around the vein prior to activation of the radiofrequency energy. As the thermal energy is delivered, the vein wall shrinks and the vein is sealed. The catheter is slowly removed and an ultrasound scan checks that the procedure has been successful (see figure 2). This will successfully treat 80% of visible varicose veins. Some people prefer concurrent phlebectomies or foam sclerotherapy to guarantee all visible varicose veins are treated during one session. With the vein sealed you will usually be placed in bandages or stockings with full instructions provided for your ongoing care upon discharge.
What are the risks?
The vast majority of patients undergoing endovenous ablation therapy do not suffer any significant complications. The leg can be sore for the first 1-2 weeks post-surgery and may be bruised, but this improves quickly. Possible complications of endovenous ablation therapy include; •Early complications: •Local oWound related (rare): Bleeding/oozing: Infection Fluid collection oInjury to surrounding structures Thermal injury can occur to surrounding nerves (saphenous and sural nerves) resulting in numbness in the ankle/calf. This is rare but if it does occur may not improve with time. oResidual varicose veins: Endovenous ablation therapy alone will successfully treat 80% of visible varicose veins by removing the underlying cause. Those visible varicose veins that remain at follow up can be treated with phlebectomies or foam sclerotherapy. Small spider veins may temporarily become more prominent after most endovenous ablation therapy oBlood clot in leg (deep vein thrombosis, DVT): You will receive a dose of heparin during your procedure to reduce the risk of peri-operative DVT. It is important that you follow post-discharge recommendations of regular mobilisation, compression stockings etc. to mitigate the risk of DVT during the first six weeks post-surgery. Damage to the deep venous system: This is extremely rare and our surgeons have not encountered this as a complication of their practice. •Systemic oSystemic complications are very rare from this type of surgery •Late complications •Recurrent varicose veins: If your surgeon reviews your leg 10 years post-surgery he/she will identify recurrent varicose veins. These most likely will not be to the same extent as before your surgery and may not be causing symptoms, but the brutal reality of varicose vein surgery is that they do recur over time. •Scarring oThere will be a subtle scar (1-2cm) evident in the leg at the site of catheter introduction. This will gradually fade with time but will not tan thereby becoming more prominent in the summer months.
What happens after the operation?
You will be able to walk out of the hospital after your procedure and after the nursing staff have checked your blood pressure and dressings. You will be discharged with appropriate post-operative instructions on your care to help reduce complications. •You should not drive home and should arrange appropriate transport. •You must have an able bodied person with you for 24 hours with access to a telephone in case of emergency. •Your leg may be uncomfortable once the local anaesthetic has worn off and your leg will be slightly swollen. You will be given painkillers to take home with you and you should follow the instructions on the packet. •You should wear your compression stocking for two weeks. During the first week day and night, during the second week day only. •We recommend that you take a minimum of three 20 minute walks each day for the first 4 weeks post-procedure.
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Figure 1: Endovenous laser ablation (EVLT) catheter being introduced to treat great saphenous vein
Figure 2: Illustration of technique of thermal ablation therapy using radio frequency energy. (Click image to enlarge)
When will I be able to drive and return to work?
We advise that you do not drive for at least 48 hours after the procedure and you should only drive when you are pain free and able to safely perform an emergency stop. You can usually return to work within one week depending upon your recovery and the type of work that you do. Avoid strenuous exercise for a few days and then gradually build up the amount you do. We do not advise any form of air travel for at least six weeks after the procedure.
Will I need to see the surgeon again?
You will be reviewed in clinic approximately 6 weeks following discharge.