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What is Radiofrequency Ablation for Varicose Veins?

Radiofrequency ablation (RFA) is a minimally invasive procedure performed to treat varicose veins (enlarged leg veins) with heat produced from radiofrequency energy.

Normally, blood travels from the heart to the lower limbs by arteries and back to the heart through veins. Veins have one-way valves that enable blood to return from the lower limbs against gravity. If the blood pools in the veins or the valves leak, the veins can become varicose or enlarged. Varicose veins result from defective valves in the superficial venous system which causes blood to pool in the leg as it is not effectively returned to the heart. They appear twisted, bulged, and blue, red, or flesh-coloured. They are swollen and raised above the surface of the skin and are mostly found on the thighs, back of the calves, and inside of the leg.

Radiofrequency ablation utilises radiofrequency waves to produce heat and seal off or close off the affected varicose vein. This closure of the vein compels the blood to go around the damaged vein to healthier veins and helps to minimise pressure and swelling in your leg, thereby resulting in the disappearance of varicose veins. RFA is an outpatient procedure that takes an average of 35 to 40 minutes to perform.

Indications for Radiofrequency Ablation for Varicose Veins

Radiofrequency ablation for varicose veins is indicated to prevent complications and treat symptoms associated with varicose veins, such as:

  • Superficial venous thrombosis
  • Skin discolouration
  • Ulceration
  • Fibrosis (formation of excess connective tissue)
  • Itching
  • Restless legs
  • Aching
  • Cramps
  • Heaviness
  • Tired legs

Preparation for Radiofrequency Ablation for Varicose Veins

Pre-procedure preparation for radiofrequency ablation for varicose veins may involve the following steps:

  • A review of your medical history and a physical examination are performed by your doctor to check for any medical issues that need to be addressed prior to the procedure.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could compromise the safety of the procedure.
  • You should inform your doctor if you have allergies to medications, anaesthesia, or latex. In addition, you should also inform of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
  • You may be asked to refrain from certain medications such as blood thinners or aspirin or vitamin/herbal supplements for a week or two prior to the procedure.
  • You should refrain from alcohol or tobacco at least a few days before treatment and several weeks after, as it can hinder the healing process.
  • You are advised to arrange for someone to drive you home after the procedure.
  • Written consent will be obtained from you after the procedure has been explained in detail.

Procedure for Radiofrequency Ablation for Varicose Veins

In general, the minimally invasive radiofrequency ablation procedure for varicose veins will involve the following steps:

  • You will lie down on the procedure table in a face-down or face-up position depending upon the site of treatment.
  • An imaging technique, such as ultrasound, is utilised to guide the procedure.
  • The leg to be treated is administered with numbing medicine to reduce any discomfort and keep you comfortable.
  • Once the skin is numb, a needle is used to make a small puncture hole usually just below the knee or occasionally at the level of the ankle.
  • Under ultrasound guidance, a catheter is inserted through the puncture hole in the skin and is positioned into the abnormal vein.
  • A radiofrequency electrode is then moved through the catheter exposing the tip of the electrode at the site to be treated.
  • Additional numbing medicine may be administered around the abnormal vein prior to ablating (destroying) the varicose vein.
  • Radiofrequency energy is then applied at the treatment site to heat up the entire length of the vein and seal it closed. This results in the stopping of blood flow through the vein.
  • The problem vein eventually shrinks and fades away, eliminating vein bulging at its source and resumption of efficient blood circulation through other healthy veins.
  • The catheter and radiofrequency electrode are removed, and the puncture hole is covered with a small dressing.

Post-procedure Care and Recovery

In general, post-procedure care instructions and recovery after radiofrequency ablation for varicose veins will involve the following steps:

  • You may experience pain, inflammation, and discomfort in the treated area. Medications are prescribed as needed to manage these.
  • Instructions on bathing and incision site care will be given to keep the incision site clean and dry.
  • Application of ice packs over the treated area is also recommended for 10 minutes at a time for a few days to control bruising, swelling, or pain.
  • You are advised to wear compression stockings for a few days to weeks as it can help prevent blood pooling or clotting, as well as leg swelling.
  • You are encouraged to walk 10 to 20 minutes about 3 times a day for a couple of weeks, but refrain from strenuous activities, lifting heavyweights, jumping, or running during this period.
  • Do not stand, sit, or lie down for long periods of time. Keep your legs elevated while sitting.
  • You should be able to resume most of your normal activities and return to work in a day or two.
  • You need to call your healthcare provider if you have a fever or notice swelling, pain, or infection at the catheter site despite taking your prescribed medications.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Radiofrequency ablation for varicose veins is a relatively safe procedure; however, as with any procedure, some risks and complications may occur, such as the following:

  • Blood clots or deep vein thrombosis (DVT)
  • Bleeding
  • Infection
  • Pain
  • Bruises/swelling
  • Damage to adjacent nerves or vessels
  • Skin burning or irritation over the treatment area
  • Skin discolouration

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