Endovenous Thermal Ablation
This treatment is a modern alternative to traditional invasive surgical vein stripping. With this procedure, there is no need for bed rest, inactivity, hospital admission or general anaesthetic. No incisions are made meaning there are no scars. It is also considered to have a lower recurrence rate compared with surgical stripping.There are two types of thermal ablation used – Radiofrequency Ablation (RFA) and Endovenous Laser Therapy (EVLT). The only difference is the energy used to generate heat. RFA uses electrical current, while laser uses light, which is, then amplified to produce a powerful beam. Our surgeons choose to use RFA because it has a lot less complications in particular less pain post procedure.
What to expect
During this treatment local anaesthetic is used to minimise any feelings of discomfort. A light sedative can be used to reduce feelings of anxiety, many patients sleep through the procedure.
A fine fibre is delicately passed along the abnormal vein to seal the vein with heat. This actively prevents the accumulation of blood in the incompetent vessel, and flow stops in the unhealthy vein. Blood is re-routed to healthy veins in the leg. High-resolution ultrasound is used to monitor the treatment process.
After the treatment, compression stockings are applied to help reduce the risk of the vein reopening. You will be advised on how to care for and wear these by a registered nurse on the day of your procedure. Before leaving the clinic, we will ask you to walk for 20 minutes to maximize the effects of the treatment. You will be able to resume normal activity the following day.
Advantages of Endovenous Thermal Ablation
- Walk-in, walk-out procedure
- Avoid general anaesthetic
- Minimal discomfort
- Faster return to normal activity
- No scarring
Sclerotherapy is a treatment that intentionally damages the lining of veins by injecting a chemical, called a sclerosant, into the vein and inducing a chemical phlebitis or inflammation. By doing this and then applying pressure the vein walls stick together. The vein can then no longer fill with blood and so it is obliterated. The compression applied after the injection is an essential part of the therapy.
Ultrasound guided foam sclerotherapy (UGS) is a further development in which the foam injection is guided by ultrasound, and is used to treat smaller varicose veins. The ultrasound probe is able to track the needle entering the vein and ensure the injection takes place in the appropriate place. The dispersion of the foam can then be tracked using ultrasound. This is often used in combination with endovenous thermal ablation to give the best results.
Microinjection sclerotherapy is used for very fine spider veins and uses a very fine needle.
What to expect
The veins that may benefit from injections are identified. For smaller varicose veins, these are identified using high-resolution ultrasound, and chemical foam is injected. The amount of treatment that can be administered during a session will depend on the number and type of veins being treated and the amount and concentration of chemical being used.
For spider veins, a small amount of liquid sclerosant is injected into the visible veins usually at multiple sites. Many microinjections can be performed at a single sitting. Immediately after the injections the areas injected tend to become red and have a slightly inflamed appearance.
Well fitting compression stockings are an important part of the post injection regime and you will be measured up for these before the treatment session so they are available to put on immediately after the treatment. It is important to walk regularly after your treatment. Several sessions of sclerotherapy may be needed to achieve optimal results.
Following sclerotherapy for smaller varicose veins they become very hard and lumpy but this will gradually resolve and the veins will disappear. Over the first few weeks following the injection, any slight discomfort, hardness or tenderness at the injection site should gradually subside. Brown staining of the skin around the site of the injection and along the line of the treated vein is quite a common event. Most patients experience complete or near complete resolution but this can take up to 12 months after the injections.