Venefit ClosureFAST RF Endovenous Ablation

About Endovenous Ablation

Our understanding of varicose veins and how best to treat patients with this problem has improved remarkably in the past decade. This is in part due to advances in duplex (ultrasound and color doppler), a non-invasive method of studying flow in arteries and veins. Duplex is an important diagnostic tool in our office. At Petoskey Surgeons, our vascular lab (NIVA) does more than 8000 vascular studies yearly. Our vascular lab is also ICAVL accredited, a rare finding in labs in northern Michigan.

valve-illustrationsYour legs have both deep and superficial veins, and the two systems are interconnected. Normally blood circulates back to the heart via veins, primarily the deep veins. Duplex uses ultrasound pictures to visualize the vein and determine the direction, speed, and amount of flow. Duplex is a key diagnostic test used in all patients with varicose veins to identify and quantify reflux (blood flow in the wrong direction). Another term used to describe an abnormal refluxing vein is “incompetent”. The term for the illness is “chronic venous insufficiency”.

Leg veins contain one-way valves that allow blood to return to the heart even against gravity. If the valves leak (or become incompetent), blood pools in the leg veins, and the veins can become enlarged and visible under the skin (varicose veins), and other symptoms can develop even without visible varicose veins. Common symptoms of chronic venous insufficiency in the legs include:

  • Varicose veins
  • Swelling
  • Cramping, throbbing, aching
  • Heaviness
  • Fatigue
  • Night cramps
  • Itching
  • Restless legs
  • Numbness
  • Skin changes such as dermatitis
  • Skin breakdown and ulceration
  • Vein Valve Blood Flow

Endovenous ablation can close faulty superficial veins, directing the blood flow to return to the deep system, and thus avoiding blood pooling in the legs which can result in varicose veins, and the above listed symptoms.

 After a physical examination and a lower extremity venous duplex in the NIVA lab, a treatment plan is developed to close the refluxing superficial veins, and divert the flow to nearby healthy deep veins. This can be accomplished by one of the following methods:

  • Radiofrequency ablation - closure of the vein by radio wave energy (Venefit).
  • Laser ablation - closure of the vein by laser energy.
  • Sclerotherapy - chemical destruction of the vein.

vnus-illustrationsAll of the above can be performed easily in the office setting, and recovery is much quicker and easier than with surgery. The above methods have almost completely replaced the older methods of treating varicose veins and chronic venous insufficiency - surgical “vein stripping”, which had to be done in the hospital under a general anesthetic, with a much longer recovery period.

At Petoskey Surgeons, we exclusively use Venefit RF ablation to close unhealthy superficial veins. The Venefit catheters are “single use only”, unlike some centers that reuse their laser fibers on multiple patients after resterilizing the fiber. Your safety is our
priority.

Less bruising and pain are additional benefits of RF endovenous ablation.

1. How do I prepare for my for my endovenous ablation?

You will receive specific instructions before the procedure. Most importantly please remember the following:

  • You will be given a prescription in advance for a light sedative. Follow the instructions given to you.
  • You may eat a light breakfast or lunch prior to the procedure.
  • Try to stay hydrated before the procedure, and avoid coffee and sodas that contain caffeine.
  • You should bring someone to drive you to and from the office.
  • Make sure you bring your stockings with you.

2. What happens during RF endovenous ablation?

  • Your leg will be imaged again with duplex to “map out” the refluxing superficial vein.
  • Your leg will then be prepped with a skin cleanser.
  • Some local anesthetic will be given at the point at which a small catheter will be inserted into the vein.
  • The Venefit RF catheter is then inserted into the vein using ultrasound guidance.
  • The entire vein is then treated with local anesthetic.
  • RF energy is applied to the inside of the vein as the catheter is withdrawn.
  • The refluxing vein has now been sealed, and blood flow has been diverted to nearby healthy veins.
  • The tiny opening in the skin at the insertion site is closed with a Steri-strip.
  • Your compression stocking is applied.

Your procedure will be done personally by one of our surgeons, with the help of one of our registered vascular technologists and a nurse/medical assistant.

The procedure takes 45-60 minutes. Much of that is prep time to get ready to close the vein. The actual closure takes less than 5 minutes. If you need multiple veins treated, you may need a number of treatments on separate days. It is also possible you might need microphlebectomy to remove varicose veins that donʼt shrink with ablation of the GSV/SSV alone.

3. What are the risks of endovenous ablation?

  • The procedure is very safe, leaving virtually no scars.
  • The risk of infection is very low.
  • Some bruising and tenderness in expected.
  • Motrin is all that will be required to treat your discomfort.
  • Heat damage to adjacent nerves can cause numbness, which usually goes away in 3-6 mos. In 1 in 150 patients however, it can be permanent.
  • Thrombophlebitis (inflammation) in superficial veins or varicosities is not uncommon and is seen in 1 in 20 patients. This responds nicely to ice packs and NSAIDs.
  • Deep vein thrombosis (DVT) occurs in much less than 1% of cases. Blood clots in the deep veins can travel to the lungs (pulmonary embolism) which can be life
  • threatening. You can minimize the chance for DVT by:
    • wearing compression stockings as instructed.
    • walking daily as instructed.
    • not sitting for prolonged periods.
    • keeping your post-treatment duplex appointment as scheduled.
    • avoid long distance travel for one month after the procedure.
    • making sure your surgeon is aware if you have ever had a DVT in the past.

Signs of DVT include:

  • Pain in leg - especially tenderness in the calf, and discomfort when the foot is pulled upward.
  • Swelling of the leg
  • Redness to the leg

4. What are the benefits of endovenous ablation?

before-and-after

  • Excellent success rates.
  • Fast recovery.
  • No surgery is required.
  • No hospitalization is required.
  • There are fewer complications compared to vein stripping.
  • Most patients report relief of their symptoms.
  • RF ablation has a successful closure rate at 2 years of 97%.
  • RF ablation results in less bruising and pain compared to laser endovenous ablation.

To learn more, call our office to schedule a screening, and/or a formal Chronic Venous Insufficiency Duplex.