This information is intended as a general guide only. Please ask if you have any questions relating to this information.
Varicose Veins
Veins with poorly or non-functioning valves enlarge and then become varicose veins. They can have a bluish colour and bulge on the leg surface. Symptoms may include heaviness, aching, throbbing, itching and cramps or tiredness in the legs. Some patients may have skin discoloration, inflammation or ulcers on the skin.
How are Varicose Veins treated?
Varicose veins that are not causing any problems do not need to be treated. In addition many of the symptoms that people attribute to varicose veins such as heaviness, ache, cramp and swelling are also very common in patients without varicose veins and there is no certainty that treatment will help. Varicose veins can be treated with stockings, surgery, laser, radiofrequency ablation, injection (foam) sclerotherapy or a combination of these treatments depending on the size and distribution of the veins.
What is Radiofrequency Ablation?
A small cut (3mm) is made under local anaesthetic around the level of the knee through which a tiny catheter is passed into the diseased vein under ultrasound guidance. The tip of the catheter, powered by radiofrequency energy, delivers heat (thermal energy) to the vein wall. As the thermal energy is delivered, the catheter in the vein is gradually pulled back, the vein wall shrinks and the vein is sealed closed (blood will re-route itself to other healthy veins). Before delivering the thermal energy to the vein wall, a few small injections are made along the vein being treated in order to infuse a local anaesthetic solution, which acts a ‘heat sink’ to take the heat away from the structures surrounding the vein and reduces any pain felt during the procedure. A small dressing will be applied to the incision at the end of the procedure.
Immediately following the procedure you will be fitted for a full leg compression stocking which you must wear for at least 3 weeks post procedure:
- Continuous (all day and all night) for the 1st week (ie do not take off for showering etc)
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You can remove the stocking for short periods during the 2nd and 3rd week (ie to wash)
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Should the stocking get damp either gently pat it dry or use a hair dryer to dry it
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If possible, try to wear the stocking for up to 3 weeks post procedure
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The stocking helps reduce pain and bruising and increases the success of the procedure
Immediately following the procedure once your compression stocking is applied, you will be required to go for a brisk 15 min walk and then twice daily for 2 weeks.
Avoid hard physical activity (aerobics and weight lifting) for the first 48 hours.
How successful is radiofrequency ablation?
Radiofrequency ablation is just as effective as ‘open’ surgery for the treatment of varicose veins, however it is a minimally invasive technique thereby greatly reducing post operative pain, bruising, scarring and post operative complications.
The National Institute for Health and Care Excellence (NICE) recommend that patients should be offered minimally invasive thermal ablation (radiofrequency ablation) in the first instance (if possible), before considering foam sclerotherapy and then surgery.
NICE has stated that the current evidence on radiofrequency ablation, shows it to occlude the treated vein immediately upon treatment in 90-100% of patients.
National Institute for Health and Care Excellence (NICE) guidelines
Advantages
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No general anaesthetic
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Walk in – walk out procedure
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The average patient typically resumes normal activities within a few days
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Little to no scarring or bruising following the treatment
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Statistically significant lower rates of pain, bruising and complications compared to laser therapy
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Noticeable improvement in symptoms within 1-2 weeks of treatment
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Can treat two legs at one treatment sitting
Disadvantages
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Procedure takes longer than foam sclerotherapy
Will treated veins recur?
It is common after any form of treatment for varicose veins for them to recur. The recurrence rate after radiofrequency ablation is the same as surgery but radiofrequency is easier to perform, does not require general anaesthesia or hospital admission and requires limited time off work. To help prevent recurrence, we recommend wearing support stockings when standing for a long time and to take regular exercise.
Before each appointment
Do not apply moisturiser, suntan lotion or any creams to your legs on the day of your appointment for radiofrequency ablation.
Side effects to radiofrequency ablation
Common
During the treatment you may feel an aching sensation – this usually settles quickly once the stocking is applied and you go for a walk.
You may feel some discomfort after your treatment. You may take pain tablets 4-6 hourly. If there is significant pain or discomfort, remove and re-apply the stocking. Bruises at the injection site usually disappear within a few weeks.
Lumpiness and Skin Staining - The treated veins may become hard and lumpy with redness over them, and occasionally may be painful. If this occurs treatment with paracetamol and an anti-inflammatory drug such as ibuprofen helps. The redness is almost never due to infection but is simply an inflammation as the vein closes. The redness then fades to a brown stain. Both the lumps and the skin staining then fade over a period of time. The lumpiness, redness and tenderness (this is called ‘thrombophlebitis’) is normal and indicates the treatment is working.
Rare
Allergic Reactions - allergic reactions to the local anaesthetic are rare.
Infection – it is possible to develop an infection at the operation site, however it can be treated with antibiotics. Radiofrequency ablation has a significantly lower risk of infection compared with ‘open’ surgery.
Skin Burn – there is a risk of a burn to the skin caused by the heat delivered to the inside of the vein. This is why the surgeon makes a few small injections along the vein being treated in order to infuse a local anaesthetic solution, which acts as a ‘heat sink’ to take the heat away from the structures surrounding the vein and reduces any pain felt during the procedure.
Numbness - due to bruising of the nerves supplying skin, occurs much less frequently than after surgery but may rarely occur. If so it may take 6-12 months to settle.
Deep Venous Thrombosis (DVT) – (<1%, less than 1 in 100 patients), clots in the deep veins have been reported following all treatments for varicose veins. This may present as a swollen, sore and red leg. If you have any concerns please see your GP ASAP.
Pulmonary Embolus (PE) – (<1%, less than 1 in 100 patients), rarely clots from the leg can move to the lungs causing pulmonary embolus.
Flying
If you are flying or have major surgery planned for within 6 weeks of your treatment, it is very important that you notify your doctor before the procedure. We recommend no flying 4 weeks prior to treatment and for 4 weeks after treatment.
Oral Contraceptive Pill
If you are taking an oestrogen based contraceptive pill, we would advise stopping this 4-6 weeks prior to radiofrequency ablation, to reduce the risk of deep vein thrombosis (DVT).
