Radio-frequency and Laser Treatment of Veins
Endovascular laser therapy (EVLT) and Radio-frequency ablation (RFA) are relatively new techniques that uses heat to destroy the superficial veins from the inside. They are performed in clinic with local anaesthetic using needles. A small cut is made below the knee and a catheter inserted into the vein up to groin. Then a number of injections is made along the thigh to numb it. The machine heats and destroys the vein. Afterwards you need to wear stocking for one to two weeks. The procedures are performed as day cases and you will be able to go home soon afterwards.
The advantages are that it is performed under local anaesthetic and lower risks of bleeding, infection and pain. Generally patients are able to return to work in two to three days. However large varicose veins below the knee may still need surgical treatment with small operation at later stage. The risks of blood clots and nerve injury exist as per surgery.
The main difference between RFA and EVLT is in RFA a radio-frequency is used to heat up the vein while in EVLT a laser is used. The current literature suggests no significant difference between RFA and EVLT results. Long term both give good results; however like all varicose vein intervention there is a risk of reoccurrence.
What to do before the procedure?
- Please arrange someone to take you home as you will not be able to drive. You will be mobile and able to walk immediately after the procedure.
- Please wear loose clothing as you will be placed in thigh high stocking after the procedure.
- You will need to arrange 2 to 3 days off work. If you are having both legs performed or you perform heavy manual work you will need longer.
What will happen during the treatment?
An ultrasound scan is performed on the leg to identify the varicose veins and locations. A small catheter is inserted usually below the knee and a wire passed up the vein. The position of the wire is located using the ultrasound to check it is in the correct position. Local anaesthetic is the injected along the thigh up to groin to numb the skin so you won't feel the rest of the procedure. The probe is the inserted over the wire and the machine is turned on. This heat treats the vein and destroys the varicose vein. Due to the local anaesthetic you should not feel any pain. If there is discomfort then more local anaesthetic can be given.
What to expect and do after the procedure?
- At the end of the procedure the probe is removed and you will be placed in a thigh high stocking. You will be asked to walk for 20 to 30 minutes before you will be able to go home.
- Please wear the stockings for the first week after the procedure. After the first day you can take then off for showering and at night.
- Lumps, bruising and skin changes along the inside of your thigh is very common in the first few weeks after the procedure. These will gradually improve. In some patient with large veins it can take several months for skin changes to disapper.
- If you experience pain in the first few days, please take simple analgesia such as Paracetamol.
- It is important that you keep active, mobile and walk 20 to 30 minutes every day. Avoid long trips and flights in the first six weeks to reduce your risk of developing blood clots.
What are the potential complications?
- Recurrence & Adjuvant treatment: There is a chance the main vein may not be completely destroyed (3 - 5%). Small veins in the legs may not disappear after this procedure. These usually are cosmetic veins, and do not cause symptoms. If this occurs then sclerotherapy or conventional surgery can be performed at a later date.
- Pain: Usually only mild discomfort is experienced for the first few days which settles with simple analgesia like Paracetamol. In about 5% of patients the discomfort can be prolonged for several weeks.
- DVT: Blood clots in the deep system are rare after RFA but can occur after any procedure. Regular walking of 20 to 30 minutes daily for the first few weeks after the procedure will reduced your risk. Some swelling is common but if develop significant swelling then please see your General Practitioner or hospital.
- Numbness: Numbness along the inside of the lower leg can occur from nerve damage or irritation. Majority of these are temporary and do not hinder walk or other activities.
- Skin damage: There have been rare cases of heat injury to the skin. We use generous amount of anaesthetic and fluid to protect the skin to prevent this from happening.