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Endoluminal Ablation
Target Veins
This procedure has replaced the traditional vein stripping that was used to eliminate the greater saphenous and lesser saphenous veins. In some cases large branch incompetence may be treated by this means, however, the vein must be relatively free of tortuosity (twists and turns).
How it works
Either radiofrequency or laser energy is used to heat the inside of the vein. This essentially 'shrink wraps' the vein closed. The heat destroys the cells that line the vein and causes thickening and scarring of the vein wall. The damage is extensive enough that the vein does not recover and ultimately is obliterated.
Treatment Technique
This procedure is sometimes performed with conscious sedation and local anesthesia. It is most commonly performed with just local anesthetic. The leg is cleansed and a sterile drape is applied.
The vein to be treated (usually the greater or lesser saphenous veins) is accessed with a large needle. A guide wire is then inserted and a catheter is placed. This is all done under ultrasound guidance to ensure proper placement of the catheter. Next the laser filament or radiofrequency probe are placed in the catheter and positioned at the top of the vein being treated. The device is then turned on and heat is generated at the tip. The device is slowly withdrawn heating the vein as it passes. In the case of radiofrequency ablation this is accomplished under ultrasound guidance allowing for direct visualization of the closer.
Following the treatment the incisions are closed with sticky strips and the leg is wrapped in a compression dressing.
Treatment Tolerance
When performed under conscious sedation the tolerance is excellent. Patients are very comfortable and have little or no recollection of the procedure afterward. With just local anesthetic the procedure is tolerable, but frequent needle sticks and burning sensations are common and, in a few cases, more than the patient can tolerate.
Post Procedure Care
Like with other treatments a compression dressing is worn for 48 hours. The compression sock is then worn for 2 weeks by itself. Most patients will have some mild discomfort for several days to 1 week. There is occasional more severe burning pain (this is more common with the laser technique), but this also resolves within days. Bruising is usually mild. Follow-up is usually 2-4 weeks.
Results
When the 'main stem' vein is closed the downward pressure is relieved off of the lower branches and spider veins. This can result in a decrease in the color and distention of these veins. However, the damage has already been done and more often than not additional treatments such as ambulatory phlebectomy, sclerotherapy, or transcutaneous laser need to be performed to fully eliminate them.