By Jill Buterbaugh, RN, MSN, CRNP, FNP-BC
Endovenous ablation is one of the options used to treat varicose veins. The only way to treat varicose veins correctly is to destroy them. Once they meet the criteria of a “varicose” vein, they are no longer functioning and serve no purpose if left alone and can cause serious complications in time. Varicose veins are those veins in the superficial system that are more than 5 mm in diameter with at least 0.5 seconds of blood flowing in the wrong direction. Although they are called “superficial”, sometimes the veins are not visible to the naked eye. The superficial system includes all those veins from the skin surface down to the deep system.
Endovenous ablation is a procedure where a catheter is placed inside the vein and heat is turned on. The heat shrinks the collagen inside the vein closing it off. The body’s own inflammatory response will then turn the vessel into scar tissue and it will be broken down and reabsorbed. The veins are not removed from the body and nothing is left inside the body.
Are there different types of endovenous ablations?
Endovenous ablations are heat based and use either laser or radiofrequency. The procedures are done the same the only difference is the type of heat. Laser heat is around 1200° Centigrade and is applied while the catheter is slowly withdrawn from the vein. The Laser light beam is at the tip of the catheter only so it puts heat exactly where the catheter tip is. This works best if there is only a short segment of the vein that is straight enough to get a catheter into, more than one vein is being treated at the same time or the vein failed to close with radiofrequency. Radiofrequency only produced around 120° of heat and is applied in segments. The radiofrequency catheters have a 7 cm segment section at the tip where the heat is applied. This allows for repeat treatment of the same section of the vein until the vein is closed and multiple segments can be treated. This works well for long veins with straight segments, large veins or veins that failed to close after laser treatment.
Which is better, radiofrequency or laser?
Both have around a 95% efficacy rate and the same risks and benefits. The decision of which to use is generally based on the anatomy of the vein to be treated and what, if any treatment had been tried in the past.
What causes endovenous treatments to fail?
Sometimes the veins are just too large and have too much blood flow in the wrong direction. Our bodies have an amazing ability to heal themselves and sometimes over time, the vein is reopened by our own healing process. Drugs that reduce inflammatory responses may decrease the body’s response to the treatments. Failure to follow post procedure directions can also contribute.
What are the restrictions after the procedures?
There are really very few restrictions after having an endovenous ablation procedure done. You will be required to wear compression hose 24 hours a day removing them only to shower for the first three days, then from morning to night for about 2 weeks. We recommend avoiding heavy lifting, resistance training, hot tubs, and hot showers for about a week. Avoiding the sun and using sun screens will help reduce the chance of skin discoloration after the procedures. Normal day to day activities and walking is encouraged. Most people can return to work without restrictions the next day.
Are the treatments painful?
Both laser and radiofrequency endovenous ablation procedures are done with local anesthetics and are generally well tolerated. A small injection of a local anesthetic at the insertion site then several injections along the course of the vein to put in a solution called tumescent anesthesia. Tumescent anesthesia is a mixture of saline solution and lidocaine that presses the vein against the catheter, pushes the blood out of the vein into the deep system, protects the skin and surrounding tissues from thermal damage and provides some numbing. Once the injections are done, there is generally no discomfort.
Is endovenous ablation treatment right for me?
It would depend on your specific varicose veins and anatomy. Call for an appointment 814-515-9919 to find out more.