Procedure: Radio-frequency Vein Ablation

During the procedure, you may feel some pressure from the ultrasound probe, but you should not feel pain. If you experience any discomfort, pressure or pain, let us know immediately.

Once the catheter has been positioned inside the vein, we begin delivering radiofrequency energy to the inside of the vein. This energy heats the vein lining, causing it to cauterize and collapse. Your body’s natural immune system then gradually breaks down and absorbs the treated vein over time.

This procedure is called radiofrequency ablation. The technology is similar to microwave energy. Although the inside of the vein reaches temperatures of approximately 300 degrees, patients are typically comfortable because the surrounding tissue is protected with local anesthetic.

After treating the full length of the vein, patients return to the clinic within a day or two for an ultrasound to confirm that the vein has successfully closed.

During the procedure, we monitor several measurements on the equipment. That includes the treatment temperature, which is approximately 120° C (248° F); the number of treatment cycles completed; and the amount of energy (or wattage) required to heat the catheter. As treatment progresses, less energy is typically needed because the vein responds to the therapy.

Each treatment cycle lasts about 20 seconds, unless the settings are intentionally changed. We generally treat the larger section of the vein above the knee for approximately 40 seconds while smaller sections are treated for 20 seconds.

A common question is, “Don’t you need that vein?”

The answer is that your legs contain multiple venous systems. There is a deep venous system located within the muscles and a more superficial venous system closer to the surface of the skin. The saphenous veins that are treated during this procedure are part of the superficial system.

When these veins become diseased and develop venous reflux, they begin allowing blood to flow backward instead of toward the heart. At that point, they do more harm than good. Treating these veins eliminates the abnormal backward flow and allows the healthy veins to carry blood properly.

An easy way to think about it is as a one-way street. Blood from the leg veins should always travel upward toward the heart. When diseased veins allow blood to flow in the wrong direction, they create congestion and increase pressure in the legs. Closing those veins restores normal circulation through the healthier veins.

In fact, the saphenous vein is often removed during coronary artery bypass surgery even when it is healthy because the body has other veins that can adequately return blood from the legs.

During the procedure, the catheter is slowly withdrawn through the vein while each section is treated. The catheter has markings that allow us to accurately treat the vein along its entire length.

Patients often notice significant improvement after recovery. Once the swelling decreases, many experience less leg pain, less heaviness, improved walking and an overall improvement in quality of life.

Chronic venous reflux disease is progressive. Without treatment, it generally continues to worsen over time. It can eventually lead to skin changes and venous ulcers, which represent the most advanced stage of the disease.

If both legs require treatment or if another affected vein remains (such as the small saphenous vein located behind the leg), that procedure is typically performed during a separate visit.

The deep veins remain healthy because they are surrounded by muscle. As you walk, your muscles naturally squeeze these veins and help pump blood back toward the heart. This is one of the reasons regular walking is so beneficial for healthy circulation.