How Does Endovenous Thermal Ablation Work?

By Jill Buterbaugh, RN, MSN, CRNP, FNP-BC

Endovenous thermal ablation is a procedure that uses heat to seal off a diseased varicose vein.  When the vein wall is heated, the endothelial layer of the vein wall is damaged or destroyed causing contraction of the collagen fibers which results fibrotic sealing of the vein.  Basically this means that the heat causes the vein walls to contract and turn into scar tissue.  The body then breaks down and reabsorbs this tissue.  In most cases, the vein is not visible on ultrasound by a year after the procedure is done.

There are two different types of heat sources that can be used for endovenous thermal ablation: radiofrequency and laser.  Radiofrequency heat is the newer treatment available and uses a lesser intense heat but produces the same closure rates as the laser.  Both procedures are around 90% effective in treating venous reflux disease.

While radiofrequency heats the vein wall to 120° centigrade, laser heats to 1200° centigrade.  The only difference in the procedures is how the heat is applied.  With a radiofrequency catheter, there is a seven centimeter section at the end of the catheter that heats the vein walls in segments.  The segment can be treated several times until the desired temperature and closure is obtained then the catheter is pulled back and the next segment is treated.  This is repeated until the entire vein is closed. With laser, the heat is directed from the tip of the catheter.  As the catheter is pulled back slowly, the vein is sealed.

Dr. Faber takes into consideration how large the vein is, the amount of reflux (blood flowing in the wrong direction), if there has ever been treatment to that vein in the past and the specific anatomy involved to make his decision on which type of heat source to use.  The procedure for doing radiofrequency endothermal ablation and laser thermal ablation are done in the same manner and have the same risk profile.  For more information, call us at (814) 515-9919.

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