What is Vein Ablation

    
   This minimally-invasive treatment is an outpatient procedure performed using imaging guidance. After applying local anesthetic to the vein, the interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the vein and guides it up the great saphenous vein in the thigh. Then laser or radiofrequency energy is applied to the inside of the vein. This heats the vein and seals the vein closed.
   Reflux within the great saphenous vein leads to pooling in the visible varicose veins below. By closing the great saphenous vein, the twisted and varicosed branch veins, which are close to the skin, shrink and improve in appearance. Once the diseased vein is closed, other healthy veins take over to carry blood from the leg, re-establishing normal flow.

	The treatment takes less than an hour and provides immediate relief of symptoms.
	Immediate return to normal activity with little or no pain. There may be minor soreness or bruising, which can be treated with over-the-counter pain relievers.
	No scar. Because the procedure does not require a surgical incision, just a nick in the skin, about the size of a pencil tip, there are no scars or stitches.
	High success rate and low recurrence rate compared to surgery.
	The success rate ranges for vein ablation ranges from 93 - 95 percent.

Before Vein Ablation, photo courtesy of Dr. Robert Min

After Vein Ablation, photo courtesy of Dr. Robert Min

Many insurance carriers cover the vein ablation treatment, based on medical necessity for symptom relief.

Traditionally, surgical ligation or vein stripping was the treatment for varicose veins, but these procedures can be quite painful and often have a long recovery time. In addition, there are high rates of recurrence with the surgical procedures. One study found a 29% recurrence rate after ligation and stripping of the greater saphenous vein, and a rate of 71% after high ligation. These recurrence rates are similar to those reported in other studies.

    Ambulatory phlebectomy is a minimally invasive surgical technique used to treat varicose veins that are not caused by saphenous vein reflux. The abnormal vein is removed through a tiny incision or incisions using a special set of tools. The procedure is done under local anesthesia, and typically takes under an hour. Recovery is rapid, and most patients do not need to interrupt regular activity after ambulatory phlebectomy.

   Injection sclerotherapy can also be used to treat some varicose and nearly all spider veins. An extremely fine needle is used to inject the vein with a solution which shrinks the vein.

  Ultrasound-guided sclerotherapy involves an interventional radiologist passing a thin tube called a catheter into the vein using ultrasound guidance and injecting substance that causes the veins to scar and close – rerouting the blood to healthier veins. The affected vein forms a knot of scar tissue that is absorbed by the body over time.

   Behavioral changes can help prevent the formation of varicose veins. 

	Cross the legs at the ankles instead of the knees when sitting
	Avoid high heels, which limit the use of the calf muscles.
	Avoid restrictive clothing which limit blood flow in the groin or calf.
	Avoid prolonged sitting or standing.
	Take breaks to elevate the legs or walk around to help move the blood along and prevent valve failure.

   Endoscopic repair is performed in advanced cases of vascular disease involving sores or ulcers on the legs. Surgeons insert an endoscopic camera into the varicose vein via small incisions to visualize and treat the defects.

Reprinted with permission of Sirweb.org