Radiofrequency Ablation of Varicose Veins

Today, the radiofrequency ablation (RFA) procedure is an alternative method in the treatment of varicose veins. The procedure also known as endovenous RFA is a minimally invasive technique to treat varicose veins. The procedure involves making a very small incision near the knee and threading a small catheter in the vein up to the groin. Radiofrequency waves are applied and the vein is heated. The heat destroys the vein and with time, the vein disappears. This novel procedure is done as an outpatient, involves a small incision and results in rapid recovery.



How does the RFA procedure work?

The RFA probe is inserted into the vein and when the probe is activated it heats up the vein. The heat energy generated by the RFA probe causes the vein to collapse. Once the vein is collapsed, it is replaced by a thin fibrous scar. This is a permanent procedure and there is no chance of varicosities occurring in the area.



How should I prepare for the procedure?

There are no special preparations required for RFA. During the procedure, you will be given a pair of dark glasses to protect against the laser beam. If you are taking Aspirin or any blood thinners, you will need to discuss this with your doctor. In most cases, blood thinners should be stopped at least 1 week prior to the procedure.



How is RFA done?

RFA is done as an outpatient procedure. The procedure is done under ultrasound visualization. At the clinic you will be asked to lie down on a bed. You will be asked to change into a hospital gown and your leg will be exposed up to the groin. The leg will then be cleaned with an antibiotic solution and you will be appropriately covered with sterile towels. A small amount of local anesthetic will be injected in the thigh area just above the knee. Using Ultrasound the vein will be identified and a small tube (catheter) will gently be inserted. The catheter is guided all the way up to the groin area under ultrasound visualization. When the catheter is in the correct place, the RFA is started. Energy is generated through the catheter and the catheter is slowly pulled out. As the catheter is withdrawn, it heats up the vein causing it to collapse.

After the procedure, a small dressing is applied to the thigh incision and a compression dressing is applied around the thigh.

How long does the RFA procedure take?

The average time for the procedure is about 30-45 minutes. One can expect to be at the doctor's office for about an hour.

Is RFA painful?

There is some mild pain during the procedure. However, prior to the procedure, the doctor will inject some local anesthetic to numb the area.

When can I return to normal activities?

It is highly recommended that you resume your normal activities the next day. Except for strenuous exercise or heavy lifting, most other activities can be resumed the next day. Sporting activities can usually be resumed in of 5-7 days.

When will the results of RFA be seen?

The vein eventually dries and shrivels up. This takes about 10-14 days. The final results will be obvious after a few months.



What are side effects of the RFA procedure?

Some individuals may have mild bruising or swelling. This disappears in 10-14 days.



What are the benefits of RFA?

Compared to the traditional varicose vein surgery procedure, RFA has a number of benefits which include:

- it is relatively fast and safe

- less extensive procedure

- there is minimal pain after the procedure

- there is less bruising

- there is less pain

- there is only one very small incision

- there is little downtime, most individuals are able to return to work in 1-2 days

- there is no use of general anesthesia



What are potential complications associated with the RFA procedure?

Complications are rare with the RFA procedure but can occur. Potential complications include:

- vein perforation

- blood clot formation

- blood clot in lungs (pulmonary embolism)

- inflammation of the vein (phlebitis)

- blood collection (hematoma)

- infection

- paresthesia (numbness or tingling)

- Skin burn.

- Nerve damage

- bruising of the skin

- pain

- failure of the procedure to work

Is RFA procedure suitable for everyone?

The RFA procedure is only used to treat the large varicose veins. It is not suitable for spider veins. Normal veins should not be removed, because future open-heart surgery may require the use of these veins. RFA procedure should only be used to treat individuals with large varicose veins in the thigh area.



What are the limitations of RFA procedure?

In those individuals with tortuous and small thrombosed varicose veins, the physician may not be able to pass the catheter through it. The procedure is only used to treat large varicose veins above the knee. Varicosities below the knee are not treated with RFA.

How does one treat the smaller veins which are left over?

One may treat any residual spider veins or vein branches with either laser or sclerotherapy.

How effective is the RFA procedure?

Most data indicate that RFA is 100% effective when done by a physician who has been trained in this technique. Failures of RFA are either related to a faulty device of lack of experience on part of the physician.

How do I know that my vein has disappeared?

After 1-3 weeks, you will be seen by the physician who will perform an ultrasound to confirm that the vein has closed off.

Is RFA treatment covered by insurance?

If you have confirmed varicose veins and any symptoms, most insurance companies will cover the cost of the RFA procedure in part or in full. However, most insurance companies will want a trial of stockings and exercise before RFA is undertaken. For those with no medical coverage, the average cost of RFA ranges from $200-500.