Patient Information Leaflet - Radiofrequency Ablation or Laser therapy

You have varicose veins which can be treated using endovenous techniques by radiofrequency ablation or laser therapy.

This information leaflet tells you about the procedure. Please read it carefully and ask your surgeon if you have any questions or concerns. Other alternatives include an operation or injections and please ask your doctor about these if you require further information.

What is Radiofrequency ablation (VNUS closure) and Laser therapy (EVLT)?

They are both minimally invasive treatment options for varicose veins. They treat the varicose veins by the principle of heat induced damage to the inner lining of the veins by using radiofrequency or laser energy. A special narrow tube (catheter) is attached to a radiofrequency or laser generator which is used to obliterate (close) the faulty vein using locally directed heat, redirecting blood through nearby healthy veins as a result.

The procedure is often performed under general anaesthetic. You will be able to go home on the day of treatment in most instances and occasionally the next day if there is considerable distance to travel.

Before the procedure

You will be asked to sign a consent form in clinic or on the day of the procedure. Marks will be made on the leg to identify the site and side of surgery.

Whilst the procedure is generally not particularly painful, there is some inevitable post- operative discomfort. It is a good idea to have some paracetamol and ibuprofen to take when you get home if you are able to take these medications.

What will happen during the treatment?

You will be taken into the operating theatre and will be greeted by our team. Your name and procedure will be checked and you will be asked about allergies.

You will be measured for support stockings to wear after the procedure. You will be placed on the operating couch and once you are asleep under anaesthetic, a cleaning solution will be painted on your leg(s).

An ultrasound scan will be used to mark the veins that require treatment. A small flexible wire will be passed into the vein and a narrow tube (sheath) is passed over this wire and then the radiofrequency or laser probe is threaded through the tube. The position of the probe will be checked and further local anaesthetic will be injected around the vein.

The generator then creates heat energy to seal the vein from the inside. This takes just a few minutes. Once the vein has been sealed the probe is removed. You will have multiple small incisions measuring less than 5mm to remove varicosities below the knee joint or multiple injections to collapse these veins.

Finally, a bandage is applied to the leg. This is kept for 24 hours and changed to stockings the next day. The stocking should be worn for 2 to 4 weeks.

What will happen after the treatment?

You will be taken back to the ward area for a short while after the operation. Once you can walk safely and feel fine you can go home. You should not drive yourself home. Normal activity including work can be resumed as soon as you like, although contact sports, heavy exercise and swimming should be avoided for 1 to 2 weeks.

When the bandage is taken off, you may see some bruising or hardness under the skin. This is quite normal and will gradually settle. You should wear your stocking(s) during the daytime for up to 4 weeks but you may remove them at bedtime or for bathing.

What advantage does endovenous treatment have over conventional surgery?

  • Normal activity can be resumed straight away and you should be able to return to work within a few days after the procedure
  • Removes the need for a groin incision in the skin, leaves fewer scars and less potential for complications such as wound infection and pain following surgery.
  • Shown to cause much less pain and bruising than conventional surgery.

What are the potential complications?

  • Some patients have bruising and tenderness that lasts longer than a week. This bruising is more common if you have had varicose veins removed through surgical incisions at the same time as the endovenous treatment.
  • It is not uncommon for some discomfort to develop around the obliterated vein between 5 and 10 days after the procedure due to inflammation. If this occurs you may require anti-inflammatory tablets such as ibuprofen, unless there are contraindications.
  • Some patients experience numbness in the leg after endovenous treatment and this is usually temporary, although it can be permanent.
  • There is a small risk of skin burns from the catheter
  • As with any surgical procedure there is a small risk (1:1000) of blood clots forming in the main leg veins (DVT), although this is less common than with conventional surgery.

The procedure will not necessarily get rid of all the bulging veins in the lower leg. It is designed to reduce the pressure in them; they often shrink but may still be visible.
If there is significant bulging and further scans reveal more leakage in the veins, then you may require further treatment.

When can I fly after this procedure?

Although the risk of blood clots is minimal with this endovenous technique we do not advise patients to undertake air travel within four weeks of the procedure.

Please do not hesitate to contact Dr Mylankal’s rooms or the hospital if you have any further queries or concerns.