The Vein Clinic of Dallas
Radiofrequency Ablation
Radiofrequency ablation (RFA) is a minimally-invasive procedure used to treat the largest non-visible varicose veins deep to the skin’s surface (saphenous veins). These are typically the source of vein disease and feed the ropey varicose veins visible on the legs. Over the past decade, RFA has emerged as the gold standard treatment with high success rates, short recovery times and minimal discomfort for patients. This treatment has effectively replaced surgical vein stripping and offers much improved results.
How does radiofrequency ablation work?
RFA uses high-frequency radio waves to create just the right amount of heat to seal the problematic veins. The radiofrequency energy is administered in 20-second bursts directly into the vein through a tiny catheter. This causes the collagen in the vein wall to shrink and prevent blood from circulating through this abnormal vein. After the vein seals, the body naturally reroutes the blood through other healthy veins, improving circulation and resolving symptoms. This process is virtually painless.
How is radiofrequency ablation performed?
We begin with ultrasound imaging of the abnormal varicose vein to accurately trace its pathway, determine the exact access site for the ablation catheter and to mark the required position of the catheter tip.
Your leg is sterilized and local anesthetic is applied to the treatment area. Using ultrasound guidance, the radiofrequency catheter is advanced into the abnormal vein through a 1-2 mm skin incision, commonly above or below the knee. This tiny incision is painless, does not require a stitch, and leaves virtually no scar.
Once the catheter is in the appropriate treatment position, diluted local anesthetic (tumescent solution) is applied generously along the length of the vein. This is performed to enhance patient comfort, provide a heat sink to protect surrounding tissues and most importantly to empty the vein and improve contact between the radiofrequency fiber and the vein wall.
The ablation catheter is then activated generating controlled radiofrequency energy at the tip. This heats the vein wall and permanently collapses the vein as the catheter is pulled back. The temperature of the vein is monitored and kept at a consistent level to ensure the vein is heated gently. This is a painless process and occurs over approximately 1-2 minutes.
During the entire procedure, patients typically rest comfortably, or listen to music.
What are the advantages of Radiofrequency Ablation?
- Considered the gold standard treatment for varicose veins, effectively replacing saphenous vein stripping surgery.
- Walk in-walk out office-based procedure lasting under an hour.
- Virtually painless requiring only local anesthetic. No general anesthesia.
- Minimally invasive with almost immediate return to normal activities.
- Tiny 1-2 mm incision requiring no stitches and virtually scar free.
- Highly successful – 92% closure rate at 5 years.
How effective is Radiofrequency Ablation?
Very effective! Radiofrequency ablation is FDA approved and has replaced any need for surgical stripping. Published clinical studies demonstrate 97-98% initial success rate with a virtually pain free treatment process, far fewer complications and extremely quick recovery period.
Importance of Ultrasound during treatment
Ultrasound imaging is an integral part of the procedure. It essentially creates a map of your vein network and helps guide the ablation catheter through the vein. Since Dr. Poonawala is a vascular interventional radiologist, he has extensive training and years of experience in ultrasound imaging and image-guided procedures. This means he is an expert at guiding the ablation catheter to the exact location effortlessly, ensuring precise treatment and minimizing complications.
Additional Information - Radiofrequency Ablation
No. Although varicose veins carry blood, they are no longer effective in returning blood back to the heart and are the root cause of the troublesome symptoms. After treatment, the blood that used to flow through the faulty veins will be diverted to the many normal veins in the leg, improving circulation and resolving symptoms.
The entire procedure takes approximately 45 minutes. If you need multiple veins treated in both legs, you may need a number of separate treatments over a period of 3-4 weeks.
Radiofrequency ablation is so minimally invasive that most patients return to their usual daily activities right away. We will recommend some mild exercise like walking to ensure good blood flow in your legs and decrease discomfort. Additionally, compression socks will be required to ensure excellent cosmetic outcomes.
- You do not need to stop your medications prior to treatment, unless otherwise advised during your consultation.
- Fasting is not required. If your procedure is scheduled for the morning, be sure to eat breakfast. However, try to avoid caffeinated beverages such as coffee and soda.
- Do not shave your legs immediately prior to your treatment.
- Wear loose clothing to the procedure appointment. Your leg will be wrapped in dressing material and compression stocking placed after the procedure.
- Our patient care specialists will go over the post treatment instructions in detail and provide you with a copy to take home.
- Compression stockings will be worn continuously for the first 48 hours. Following this, the stockings should be worn for a minimum of 14 days during the day. They can be removed for showering and sleeping. The longer you wear them, the fewer the side effects and better the results.
- You may resume normal activities but avoid standing still for long periods of time. Many of our patients even return to work after the procedure.
- You will need to walk a minimum of 30 minutes each day for at least 3-4 weeks after the procedure. This is crucial to obtain the best results, avoid complications and make your leg feel more comfortable.
- You may continue your normal exercise routine, except for strenuous and high impact exercises such as running and jumping for 2 weeks. Walking is highly encouraged.
- Avoid long distance travel > 5 hours for the first 3 weeks. If this is unavoidable, please let us know.
- A followup ultrasound evaluation of the treated vein will be performed 3-5 days after the procedure. This is to ensure treatment success and to exclude the very low chance of deep vein thrombosis.
- We believe in treating patients like family. You will have Dr. Poonawala’s after hours number should you have any questions or concerns.
The common side effects which are a normal response to the treatment, are harmless and transient. They are expected and should not be a cause for concern although they should be reported on follow up.
- Roughly 25% of patients report no pain after the procedure, 50% report some discomfort but not enough to warrant taking pain medicine, and the remaining 25% have enough discomfort to warrant taking pain medicine. Discomfort will typically be the worst for the first 1-2 days with gradual decrease and resolution thereafter. Discomfort should be managed with a combination of light walking, rest with leg elevation, compression stocking wear and anti-inflammatories such as Ibuprofen or Naproxen.
- Skin bruising along the treated vein length may occur and is merely a result of the body’s natural inflammatory response to the procedure. This will typically disappear within two or three weeks and can be minimal to extensive. The bruising can look quite dramatic though it is not painful.
- It is important to continue walking daily and adhere to the compression stocking regimen. This will ease discomfort and significantly decrease recovery time.
- Significant complications are rare. If you have any untoward symptoms such as severe leg pain, significant redness/inflammation along the treated vein, or swelling of the leg, you need to contact us.
Radiofrequency ablation has been proven to be remarkably safe and well tolerated in a large number of clinical studies, although complications can occur even with the best possible technique and attention to detail.
Allergic reactions – Allergic reactions to the local anaesthetic or sclerosant solutions are exceedingly rare although are possible with any medication. The equipment necessary to treat allergic reactions are on site.
Infection – Radiofrequency ablation is a sterile procedure. Meticulous care is taken to maintain a sterile field during treatment. If you develop significant redness around the treated area, pain, swelling and/or fever, you should contact the clinic immediately.
Deep Vein Thrombosis – Blood clots in the deep veins of the leg following radiofrequency ablation is rare. The necessary daily walking and compression stocking regimen are preventative. The deep veins are carefully assessed with ultrasound prior to the procedure and again at the follow-up appointment.
Nerve Damage – There are a few areas in the leg where treatable veins lie adjacent to significant nerves. Since Dr. Poonawala is a formally trained and experienced radiologist, he is an expert in anatomy and ultrasound imaging. Nerves are accurately identified with ultrasound and the treatment algorithm is adjusted to avoid damage. Consequently, nerve injury is exceedingly rare and any associated areas of skin numbness post procedure are most often temporary and resolve spontaneously.
- RFA utilises radiofrequency waves rather than invisible laser light to heat and seal the vein shut.
- Due to differences in technology, the maximum temperature required to seal the vein shut with RFA is 120 degrees celsius as opposed to temperatures exceeding 1000 degrees celsius with EVLA. This means that RFA is much more gentle and refined, translating to less bruising and discomfort post procedure. In addition, the lower temperature offers slightly lower complication rates overall.
Although the differences between the two procedures are few, our team may prefer one type over the other depending on the patient. Typically, EVLA tends to be better suited for patients whose internal veins are larger in diameter or if blood clots are present. For others, RFA may be the better option due to decreased discomfort and bruising, and lower complication profile.
