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Varicose vein ablation can help to treat patients with symptoms of chronic venous insufficiency. The procedure is often carried out due to cosmetic concerns.
Consultation for referral purposes with a GP, vascular physician or vascular surgeon.
Preprocedural consultation with an interventional radiologist or other medical practitioner specially trained to carry out these procedures.
Venous duplex Doppler studies that may or may not be carried out with the procedural specialist in attendance, to document that the deep vein system is patent and map venous insufficiency.
Varicose vein ablation should only to be carried out in ambulatory patients.
No long distance flights of more than 1 hour should be taken duration during treatment, or for 4 weeks after treatment
A thrombophilia screen may be undertaken based on VTE history and age.
Hypercoagulable states, see thrombophilia screening
Infection of the leg to be treated
Deep venous disease resulting in acute or chronic blockage of major deep venous drainage
Tortuous great saphenous vein making placement of the laser fibre/RFA catheter difficult
Not able to wear compression stockings
Hormonal replacement or contraceptive pill
Peripheral arterial insufficiency of any kind
Thrombophlebitis with healing is the process through which this procedure treats the varicose veins. Therefore, symptoms of thrombophlebitis are expected and can be treated with anti-inflammatory agents, ice, and wearing stocking night and day. Significant bruising occurs 1 in 20 patients.
Reports of major complications following endovenous ablation are rare.
Post-procedure DVT occurs in less than 1% of patients.
Thrombus extending into the femoral vein (8%).
Paresthesias from perivenous nerve injury are usually temporary and generally resolve over 3–6 months. Rarely this is chronic.
Thermal injury to the skin. Reported where the volume of local anaesthetic was not sufficient to provide a buffer between the skin and the vessel, especially below the knee.
There has been one report of an arteriovenous fistula that developed after EVLA of the short saphenous vein.
No alternative imaging tests other than ultrasound are generally required.
Surgical stripping of the GSV and SSV or sclerotherapy of the same vessels can be offered as alternatives to EVA.
Trapped blood, if not released (by the proceduralist at the time of routine post-treatment review), can lead to brown pigmentation of the skin and may take 4–6 months to resolve.
eMedicine: Varicose Veins Treated With Radiofrequency Ablation Therapy
eMedicine: Varicose Vein Treatment With Endovenous Laser Therapy:
Animated YouTube video – Varicose Vein Ablation & Closure:
Society of Interventional Radiology:
Animated YouTube video – EVLT Varicose Vein Laser Treatment:
Page last modified on 26/9/2016.
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