Venous Ablation - Types, Uses, Procedure, Instructions, Risks, and Limitations

What Is Venous Ablation?

The circulatory system in the human body is a complex and dynamic process involving the heart, blood arteries, and veins. The blood is moved from the heart to the peripheral areas through the arteries and from the periphery to the heart by the veins. These veins usually contain valves that operate in a one-way system that helps the blood return to the heart against gravity. An increase in pressure in the veins causes the veins to stretch and weakens their walls. This results in damaging the valves because of which the blood tends to accumulate, appearing as bluish or purplish bulging veins, which are also known as varicose veins. Varicose veins can be caused by many factors, including aging, prolonged standing or sitting, or can be hereditary also. Though varicose veins are not dangerous, they can cause some discomfort to the patients. They can be painful and itchy and may also result in swelling and discoloration. Some patients may find relief with some home remedies; however, few of them may require medical management.

Vein ablation is one such procedure that is used in the treatment of varicose veins. It is a very safe procedure that burns and seals the veins causing varicosities, and diverts the blood to adjacent healthy veins.

What Are the Types of Venous Ablation?

Vein ablation, or endo-venous ablation as they are commonly referred to, is usually of three types as mentioned below:

1. Laser Ablation: A laser is used to close the varicose veins.

2. Radiofrequency Ablation: Heat is used to seal the defective veins causing varicosities.

3. Sclerotherapy: It is mostly used for smaller varicose veins. Chemical agents are used in this procedure.

What Are the Uses of This Procedure?

Venous ablation of varicose veins is usually performed if patients are symptomatic or more for a cosmetic reason. They are done under the following conditions:

• If the varicosities are causing extreme pain, itching, or resulting in decreased mobility due to swelling of the legs.

• If ulcers have started developing on the external surface of the varicose veins due to the excessive pressure buildup.

• Resulting in discoloration of the skin.

• Patients with varicose veins are more susceptible to the formation of blood clots. Hence venous ablation can reduce the risk of a blood clot and any further associated complications.

• Restless leg syndrome (uncontrolled desire to move the legs).

What Are the Instructions Before the Procedure?

• Patients might be advised to take certain blood tests before the procedure.

• Patients should report to the doctor all the medicines, supplements, and over-the-counter medicines taken by them. The patient should notify the doctor of any history of allergies.

• Patients who are on non-steroidal anti-inflammatory drugs, blood thinners, or Aspirin may have to consult the doctor as these medicines may have to be stopped, or their dose should be adjusted before the procedure.

• They can wear comfortable clothes and remove jewelry and accessories before the procedure.

• Patients should carry all their recent test reports while going for the procedure.

• Patients should carry compression stockings which should be worn immediately after the procedure.

How Is the Procedure Done?

• Venous ablation is usually done on an outpatient basis, and the procedure takes one to two hours. For multiple veins, treatment may be done in four to six weeks.

• The patient would be made to wear a hospital gown and be taken to the treating room.

• With the help of ultrasound, the vein to be treated will be first traced.

• The area would then be cleaned, shaved and sterilized using an antiseptic solution.

• The area where the incision is to be made will be anesthetized using a local anesthetic.

• A small incision will be made over the skin at the site, through which a catheter will be inserted into the varicose vein. This will be done with the help of an ultrasound. The patient might experience some pressure when the catheter is inserted but no pain.

• A local anesthetic will be injected surrounding the vein so that the vein collapses around and acts as a heat insulator.

• The laser fiber or the radiofrequency electrode will be inserted into the vein through the catheter, which will be partially exposed inside by pulling the catheter marginally.

• Protective glasses will be given while using laser ablation.

• The heat energy emitted by the laser or the radiofrequency electrode closes and seals the vein, thus shrinking them.

• The catheter is removed slowly.

• The skin incision site may be covered with a small dressing, and no sutures will be needed.

• Compression stockings may be used immediately.

• In sclerotherapy, a chemical substance is injected into the vein through a small fine needle that is inserted through the skin incision. This would result in scarring and closure of the veins. A local anesthetic is not needed.

What Are the Instructions After the Procedure?

• Patients should wear compression stockings to minimize pain or soreness and also to prevent the formation of blood clots. It should be worn day and night for the first four days and for the next ten days only during day time.

• Should walk for 30 to 40 minutes daily for 14 days starting as soon as the procedure is complete.

• The patients can resume their daily activities.

• Should avoid air travel and long hours of sitting.

• Patients should remain active; however, avoid any physical exertion.

• When not mobile, patients are instructed to keep their limbs elevated.

• Patients should avoid swimming and hot tubs.

• Painkillers may be prescribed for general soreness, which may be there for two or three days after the procedure.

What Are the Benefits of This Procedure?

• Reduced pain as compared to routine surgical treatments such as ligation and vein stripping used in varicose veins.

• Esthetically far superior as no scarring.

• Less invasive.

• Speedy recuperation.

• Immediate relief from the symptoms.

What Are the Risks Associated With This Procedure?

• Minimal pain, swelling, and discomfort.

• Temporary numbness in the treated vein area due to the damage caused by heat to adjacent nerves.

• The rare possibility of an infection in the skin.

• Redness of the skin surrounding the area that was treated.

• Calf pain and swelling may be suggestive of deep vein thrombosis (DVT), which may require immediate attention as it is a life-threatening situation. However, the occurrence of DVT is rare.

What Are the Limitations of This Procedure?

Not recommended in tortuous veins. There is a possibility of a few dilated small branches remaining open and may require additional treatments such as sclerotherapy or phlebectomy.

Conclusion

Varicose veins are considered to be a very common condition seen in many individuals. Most of them are asymptomatic, while few get better with certain home treatments such as compression stockings. However, few of them have intense pain and discomfort, resulting in complications if not treated. Venous ablation is a very safe and less invasive procedure to treat varicose veins. Quick recovery and superior esthetics make it convenient and easily acceptable to the patients.