Background Information:

What are the other Names for the Procedure?

• Thermal Venous Ablation of Great and Small Saphenous Veins
• Thermal Venous Ablation of Varicose Veins

What is Endovenous Ablation of Varicose Veins radiology procedure? (General Explanation)

• Endovenous Ablation of Varicose Veins is a minimally invasive treatment for varicose veins. The procedure involves using laser energy to cauterize varicose veins
• Veins are vessels that carry blood from the organs to the heart. They have one-way valves which allow blood flow against gravity. In varicose veins, these valves are weakened and leaky that causes blood to pool in the leg veins. As a result, these veins become swollen and large, and are called varicose veins

What part of the Body does the Procedure involve?

Varicose veins are often found in the extremities, so the legs are involved during the Endovenous Ablation of Varicose Veins procedure.

Why is the Endovenous Ablation of Varicose Veins radiology procedure Performed?

• Varicose veins are veins with weakened valves that are enlarged, swollen, and torturous. They can cause pain, edema in the extremities, skin ulcers, or other signs and symptoms
• Endovenous Ablation of Varicose Veins is performed to treat the symptoms of venous insufficiency such as swelling, aching pain, sores, ulcers, discoloration, and phlebitis (inflammation of veins)

What is the Equipment used? (Description of Equipment)

The following equipment is used during the Endovenous Ablation of Varicose Veins procedure:

• Ultrasound - the equipment for ultrasound imaging consists of:
  • An ultrasound transducer
  • A computer monitor
  • A central processing unit
  • A printer          

A transducer is used to send high-frequency sound waves in the body and the computer creates the image based on the echoes of that sound returning from the patient’s body. 

• Catheter: It is a long, thin plastic tube that is used to place electrodes in the varicose veins
• Radiofrequency electrodes - to deliver electrical energy to the varicose veins

What are the Recent Advances in the Procedure?

There have been no recent advances in the Endovenous Ablation of Varicose Veins procedure.

What is the Cost of performing the Endovenous Ablation of Varicose Veins radiology procedure?

The cost of Endovenous Ablation of Varicose Veins procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary. 

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Endovenous Ablation of Varicose Veins procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.ncbi.nlm.nih.gov/pubmed/25711984 (assessed on 3/9/15)

http://www.ncbi.nlm.nih.gov/pubmed/25673309 (assessed on 3/9/15)

http://www.ncbi.nlm.nih.gov/pubmed/25627262 (assessed on 3/9/15)

Prior to Endovenous Ablation of Varicose Veins radiology procedure:

How does the Endovenous Ablation of Varicose Veins radiology procedure work?

Endovenous Ablation of Varicose Veins works in the following manner:

• Ultrasound is used to visualize the varicose veins
• A catheter is inserted through the skin and positioned in the varicose vein
• Radiofrequency electrodes is inserted through the catheter and advanced into the varicose veins
• Electrical energy from the radiofrequency electrode is applied that heats up the blood vessel and closes it
• After the procedure, the varicose veins shrink, turn into scar tissue and disappear
• The blood from varicose vein is diverted to healthy veins that takes away blood from the legs to the heart effectively

How is the Endovenous Ablation of Varicose Veins radiology procedure Performed?

Endovenous Ablation of Varicose Veins is performed in the following manner:

• A local anesthetic cream is applied over the varicose vein area to reduce the pain and discomfort
• The area of varicose vein treatment is cleaned, shaved, sterilized, and surgically draped. The area of abnormal vein is numbed using a local anesthetic
• Ultrasound is used to find the varicose vein and track its path to other veins
• A small skin incision is made for catheter insertion. The catheter is inserted through the skin into the vein using ultrasound guidance. It is advanced and positioned in the varicose vein
• A radiofrequency electrode is inserted through the catheter to the varicose vein
• The tip of the radiofrequency electrode is exposed by slightly retracting the catheter
• Using ultrasound guidance, local anesthetic is applied around the abnormal vein
• Electrical energy through the radiofrequency electrode is applied to close-off the vein
• As the energy is being applied, the catheter is withdrawn. The catheter is eventually removed and pressure is applied to prevent bleeding from the insertion site
• No sutures are necessary as the skin incision is very small
• Patients are usually discharged after the procedure; but in some cases, hospital admission may be required

Where is the Procedure Performed?

Endovenous Ablation of Varicose Veins is performed as an outpatient procedure, at a hospital.

Who Performs the Procedure?

An interventional radiologist or a vascular surgeon performs the Endovenous Ablation of Varicose Veins procedure.

How long will the Procedure take?

The Endovenous Ablation of Varicose Veins procedure takes about an hour to complete. It may take longer depending upon the number of varicose veins to be treated.

Who interprets the Result?

An interventional radiologist or a vascular surgeon interprets the results of the Endovenous Ablation of Varicose Veins procedure.

What Preparations are needed, prior to the Procedure?

The following preparations are needed prior to an Endovenous Ablation of Varicose Veins:

• Patients should inform their physicians about their medical conditions, medications, and any over the counter medications or herbal supplements they are taking
• Patient should inform their physician if they are allergic to any medications, especially to local anesthetic medications and contrast material
• Patients may be asked to stop taking blood thinner medications such as NSAIDs, aspirin, warfarin, and heparin

What is the Consent Process before the Procedure?

A physician will request your consent for Endovenous Ablation of Varicose Veins procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What are the Benefits versus Risks, for this Procedure?

Following are the benefits of Endovenous Ablation of Varicose Veins:

• It is a minimally invasive procedure with much less complications than a surgical procedure
• It is very effective in the treatment of varicose veins
• The success rate of treating varicose vein with endovenous treatment is very effective than using vein stripping technique
• Most of the symptoms, such as pain, swelling, and torturous veins, disappear in a few months following the procedure

Following are the risks of Endovenous Ablation of Varicose Veins:

• Since this procedure involves inserting a catheter into the veins, there is a chance of damaging a healthy vein and causing bleeding inadvertently
• Rarely, the catheter insertion may result in an infection
• Patient may experience tenderness and bruising after the procedure
• In certain patient populations, inflammation of the veins (thrombophlebitis) may occur after the procedure which causes pain and redness over the varicose vein treated area
• In rare cases, blood clots formed in the legs may get dislodged and travel to the lung causing pulmonary embolism

What are the Limitations of the Endovenous Ablation of Variose Veins radiology procedure?

Endovenous Ablation of Varicose Veins is usually used in treating large varicose veins, as it is very hard to pass the ablation catheter through small and torturous veins. Phlebectomy or sclerotherapy procedures may have to be used to treat small vein branches.

What are some Questions for your Physician?

Some of the basic questions that you might ask your healthcare provider or physician are as follows:

• What is the Endovenous Ablation of Varicose Veins procedure?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• What are the risks while performing the procedure?
• What are the complications that might take place during recovery?
• What are the possible side effects from the procedure? How can I minimize these side effects?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any lifestyle restrictions or modifications required after the procedure is performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required after the procedure?
• Is there any medication that needs to be taken for life after the procedure?
• What are the costs involved?

During the Endovenous Ablation of Varicose Veins radiology procedure:

What is to be expected during the Endovenous Ablation of Varicose Veins radiology procedure?

• Patients may feel a slight pinprick when the local anesthetic is injected
• Multiple injections of local anesthetic are required around the varicose vein, which may cause pain
• Patient may be asked to wear protective glasses, if lasers are used in the treatment
• Catheter insertion may cause some pressure and discomfort to the patient

What kind of Anesthesia is given, during the Procedure?

Local anesthetics are used during the Endovenous Ablation of Varicose Veins procedure.

How much Blood will you lose, during the Procedure?

Since Endovenous Ablation of Varicose Veins is a minimally invasive procedure, the blood loss involved is minimal.

What are the possible Risks and Complications during the Endovenous Ablation of Varicose Veins radiology procedure?

Following are possible risks of Endovenous Ablation of Varicose Veins:

• Since this procedure involves inserting a catheter into the veins, there is a chance of damaging a healthy vein resulting in a bleeding situation
• Catheter insertion requires making a skin incision, which may cause an infection in some rare cases
• There may be some tenderness and bruising experienced after the procedure
• In certain patient population, inflammation of veins (thrombophlebitis) may occur after the procedure which causes pain and redness over the varicose vein treated area
• In rare cases, blood clots formed in legs may get dislodged during this procedure and may travel to lung causing pulmonary embolism.

What Post-Operative Care is needed at the Healthcare Facility after the Endovenous Ablation of Varicose Veins radiology procedure?

No specific post-operative care is needed at healthcare facility after Endovenous Ablation of Varicose Veins.  

After the Endovenous Ablation of Varicose Veins radiology procedure:

What is to be expected after the Endovenous Ablation of Varicose Veins radiology procedure?

• Patients may experience some pain and bruising over the treatment area after Endovenous Ablation of Varicose Veins.
• Patients are required to use compression stockings to reduce pain, tenderness, bruising and to avoid forming blood clots.
• Sometimes, inflammation of the veins with pain and redness may occur over the treated areas

When do you need to call your Physician?

Patients may need to contact their physician in the following situations after the procedure:

• If the pain, bruising, and tenderness does not resolve after a few days, and with over-the-counter NSAIDs
• If the patient experiences sudden breathing difficulties
• If any signs of infections, such as redness, warmth, pain, or swelling, is noted around the catheter insertion site accompanied by fever or chills

What Post-Operative Care is needed at Home after the Endovenous Ablation of Varicose Veins radiology procedure?

• Patients are required to use compression stockings to reduce pain, tenderness, and to avoid blood clot formation after the Endovenous Ablation of Varicose Veins procedure
• Activities involving prolonged sitting, such as long-distance traveling (air travel), should be avoided as patients are more susceptible blood clot formation. One should remain active, as it helps avoid formation of blood clots

How long does it normally take to fully recover, from the Procedure?

Endovenous Ablation of Varicose Veins does not require any recovery time. The patients may resume their normal activities immediately after the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The Endovenous Ablation of Varicose Veins procedure does not involve the removal of any body tissue.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

Since no tissue is removed during the procedure, a pathologist does not get involved in the care of the patient.

Who will you receive a Bill from, after the Endovenous Ablation of Varicose Veins radiology procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The hospital, where the procedure is performed
• Healthcare providers, physicians, and radiologists, who are involved in the process

The patient is advised to inquire and confirm the type of billing, before the Endovenous Ablation of Varicose Veins procedure is performed.