Varicose Vein Ablation

Authors: A/Prof Lourens Bester*
                            Dr Stuart Lyon *

Indications for varicose vein ablation:

Varicose vein ablation can help to treat patients with symptoms of chronic venous insufficiency. The procedure is often carried out due to cosmetic concerns.

What are the prerequisites for having varicose vein ablation done?

Consultation for referral purposes with a GP, vascular physician or vascular surgeon.

Preprocedural consultation with an interventional radiologist or other medical practitioner specially trained to carry out these procedures.

Venous duplex Doppler studies that may or may not be carried out with the procedural specialist in attendance, to document that the deep vein system is patent and map venous insufficiency.

Varicose vein ablation should only to be carried out in ambulatory patients.

No long distance flights of more than 1 hour should be taken duration during treatment, or for 4 weeks after treatment

A thrombophilia screen may be undertaken based on VTE history and age.

What are the absolute contraindications for varicose vein ablation?

Hypercoagulable states, see thrombophilia screening

Infection of the leg to be treated

Deep venous disease resulting in acute or chronic blockage of major deep venous drainage

Non-ambulatory patient

Pregnancy

What are the relative contraindications for varicose vein ablation?

Tortuous great saphenous vein making placement of the laser fibre/RFA catheter difficult

Not able to wear compression stockings

Hormonal replacement or contraceptive pill

Peripheral arterial insufficiency of any kind

What are the adverse effects of varicose vein ablation?

Thrombophlebitis with healing is the process through which this procedure treats the varicose veins. Therefore, symptoms of thrombophlebitis are expected and can be treated with anti-inflammatory agents, ice, and wearing stocking night and day. Significant bruising occurs 1 in 20 patients.

Reports of major complications following endovenous ablation are rare.

Post-procedure DVT occurs in less than 1% of patients.

Thrombus extending into the femoral vein (8%).

Paresthesias from perivenous nerve injury are usually temporary and generally resolve over 3–6 months. Rarely this is chronic.

Thermal injury to the skin. Reported where the volume of local anaesthetic was not sufficient to provide a buffer between the skin and the vessel, especially below the knee.

There has been one report of an arteriovenous fistula that developed after EVLA of the short saphenous vein.

Are there alternative imaging tests, interventions or surgical procedures to varicose vein ablation?

No alternative imaging tests other than ultrasound are generally required.

Surgical stripping of the GSV and SSV or sclerotherapy of the same vessels can be offered as alternatives to EVA.

Further information about varicose vein ablation:

Trapped blood, if not released (by the proceduralist at the time of routine post-treatment review), can lead to brown pigmentation of the skin and may take 4–6 months to resolve.

Useful websites about varicose vein ablation:

eMedicine: Varicose Veins Treated With Radiofrequency Ablation Therapy
http://emedicine.medscape.com/article/1085800-overview
eMedicine: Varicose Vein Treatment With Endovenous Laser Therapy:
http://emedicine.medscape.com/article/1085735-overview
Animated YouTube video – Varicose Vein Ablation & Closure:

Society of Interventional Radiology:
http://www.scvir.org/patients/varicose-veins/
Animated YouTube video – EVLT Varicose Vein Laser Treatment:

*The author has no conflict of interest with this topic.

Page last modified on 30/8/2018.