Endovenous ablation for varicose veins in Cairns
Endovenous ablation closes a faulty vein from the inside using heat, rather than removing it surgically. It is one of the standard treatments for varicose veins caused by reflux in the great or small saphenous vein.
Two forms are in common use: endovenous laser ablation (EVLA), which uses laser energy delivered through a fibre, and radiofrequency ablation (RFA), which uses radiofrequency energy delivered through a catheter. The principle is the same in both — controlled heat damages the vein wall, the vein contracts and seals, and over the following months the body absorbs it.
Who it suits
Suitability is determined by duplex ultrasound, not by how the veins look. The scan establishes which vein is refluxing, its diameter, how deep it runs beneath the skin and whether the deep veins are normal.
Endovenous ablation is generally appropriate where there is reflux in a reasonably straight segment of the great or small saphenous vein. It is less suitable where the vein is very tortuous, where it lies immediately beneath the skin, or in certain patterns of recurrent disease. In those situations surgery or glue closure may be the better choice.
Not everyone with varicose veins needs any procedure at all.
What the procedure involves
The leg is scanned again on the day so the vein can be marked accurately.
A needle is used to enter the vein, usually below the knee or in the calf, and a fine catheter or fibre is passed along the inside of the vein under ultrasound guidance up to the point where the reflux begins.
Local anaesthetic is then infiltrated along the length of the vein, in the tissue surrounding it. This does two things: it numbs the area, and it forms a protective layer of fluid between the vein and the surrounding tissue and nerves. This part of the procedure involves several injections and is the part most people find least comfortable.
The energy is then delivered as the catheter is withdrawn along the vein, sealing it as it goes.
Where there are prominent surface branches, these may be dealt with in the same sitting through tiny incisions, or with sclerotherapy afterwards.
A compression bandage is applied at the end.
Afterwards
- The bandage stays on for 24 to 48 hours, then is replaced with a compression stocking worn during the day and removed at night
- Normal activity resumes immediately, and walking thirty minutes a day is encouraged
- Hot baths and gym work are avoided until you have been reviewed
- Simple pain relief is usually sufficient; avoid aspirin-based products unless specifically advised
- You will be reviewed at one to two weeks with an ultrasound scan to check for deep vein thrombosis
Tenderness and firmness along the line of the treated vein for several weeks is expected — the vein is inflamed as it closes, and this settles.
Risks
Bruising along the treated vein is usual. Tightness or a firm cord under the skin can persist for a month or more.
Numbness or altered sensation in a patch of skin can occur where the vein runs close to a sensory nerve, most often below the knee or over the calf. It is usually temporary but can persist.
Superficial thrombophlebitis — inflammation and clot in a surface vein — occurs in a minority of cases and is managed with compression and anti-inflammatory medication.
Deep vein thrombosis is uncommon and is the reason for the routine scan at review. Rarely, thrombus can extend from the treated vein into the deep system, which is specifically looked for.
Skin burn, infection and bleeding are recognised but uncommon. Failure of the vein to close completely occurs in a small proportion of cases and may need further treatment.
Varicose veins can recur over time, whichever technique is used. All risks are discussed with you before any treatment is agreed.
Common questions
Is it done under general anaesthetic?
Endovenous ablation is performed under local anaesthetic, which is why recovery is quicker than after conventional surgery.
Does the leg still drain properly with the vein closed?
Yes. A refluxing saphenous vein is carrying blood in the wrong direction. Once it is closed, blood returns through the deep veins and the remaining competent superficial veins, as it should.
How does it compare with glue closure?
Both close the vein without removing it. Ablation uses heat and requires local anaesthetic to be infiltrated along the vein; glue does not, so there are fewer needles, but glue is not suitable for every vein and there are differences in cost and in the evidence base. Which is appropriate for you comes out of the duplex and the consultation.
Will I need more than one treatment?
Sometimes. Surface branches often need a second sitting of sclerotherapy after the main vein has been closed, and both legs are usually treated on separate occasions.
Referral and appointments
GPs and referrers: referrals can be sent to the rooms by fax or through the online referral form.
Patients: phone the rooms on (07) 4254 5006. Suite 9, Level 1, 193 Lake Street, Cairns.