Varicose veins are those veins that have become enlarged and twisted. The term commonly refers to the veins on the leg, although varicose veins can occur elsewhere. Veins that have pairs of leaflet valves to prevent blood from flowing backwards (retrograde flow or venous reflux). Leg muscles pump the veins to return blood to the heart (the skeletal-muscle pump), against the effects of gravity.
Our understanding of varicose veins and how best to treat patients with this problem has improved in the past decade. This is in part due to the use of duplex ultrasound, which is used to look at blood flow in the veins.
Normally, blood circulates from the heart to the legs via arteries and back to the heart via the veins. Duplex Doppler ultrasound uses ultrasound images or pictures to visualize the vein and at the same time determines the direction of the blood flow. Duplex Doppler ultrasound is carried out before treatment in all patients with varicose veins to identify reflux (blood flow in the wrong direction) that causes varicose veins to appear and to establish the pattern of the abnormality.
HOW TO PREPARE FOR VARICOSE ABLATION UNLATERAL?
When you attend the clinic or hospital where the procedure is to be carried out, you should report all medications that you are taking, including herbal supplements, as well as any allergies you have, especially to local anesthetic, or any reactions you may have had previously when undergoing sclerotherapy.
Before the procedure, you may be advised to stop taking blood thinning medication that is, aspirin, non-steroidal anti-inflammatory medications (NSAIDs) or blood thinner, such as warfarin or Clexane, for a specified period of time.
You should wear comfortable, loose-fitting clothing, and you will be asked to remove all clothing and jewellery in the area to be treated.
Remember to bring compression stockings to wear immediately after the procedure. The type you require should be discussed when you make the appointment for the procedure. The type and size of stockings you need to bring will be discussed at the preprocedure consultation with the doctor who will carry out the procedure.
You should plan to walk for 30-40 minutes immediately after the procedure and daily thereafter for 14 days.
You will need to wear your compression stockings for the first 14 days - day and night for the first four days - and then during the day, but not at night, for the next 10 days.
You may experience some discomfort (general aching or tightness in the legs or soreness in the treated vein(s) after the procedure, for which you may take paracetamol.
The procedure is carried out on an outpatient basis using local anesthetic injected around the veins.
WHAT HAPPENS DURING VARICOSE ABLATION UNILATERAL?
The leg being treated will be shaved, cleaned, sterilized and covered with a surgical drape.
If laser ablation is used, you will be given protective eyewear.
The area where a laser fiber or RFA catheter (a thin plastic tube) will be inserted into the abnormal vein will be numbed with a local anesthetic.
Under ultrasound guidance (using ultrasound images or pictures on a screen) the laser fiber or RFA catheter is inserted through a small cut in the skin into the vein and positioned within the abnormal vein.
Using ultrasound guidance, local anesthetic is injected around the abnormal vein.
Laser or radiofrequency energy is applied as the fiber or catheter is slowly withdrawn and removed. The faulty vein has now been sealed and blood flow has been diverted to the nearby healthy veins.
The fiber or catheter is removed and pressure is applied to stop any bleeding. The tiny opening in the skin is covered with a small dressing.
When sclerotherapy is used to ablate the veins, a very fine needle, smaller than a pin, is placed within the vein and a chemical substance is injected. When this is done, no local anesthetic is used.
WHAT ARE THE SIDE EFFECTS OF VARICOSE ABLATION UNILATERAL?
There will usually be some bruising, swelling with minimal pain and discomfort after the procedure. Because of the appearance of the bruising and inflammation that often occurs in the treated area, and the need to wear thick supportive stockings, you may want to consider having the procedure carried out in the cooler months of the year.
Patchy numbness in the area of the treated vein may last for a short time or may take 3-6 months to resolve.
Inflammatory changes around the vein called superficial phlebitis will show as reddening of the skin, and minor local pain and tenderness. The inflammatory changes may start 7-21 days after the procedure and may last for up to 10 days.
If you develop calf tenderness and swelling, this may indicate deep vein thrombosis. If this happens, you need to immediately contact the radiology department or practice where you had the procedure.
WHAT IS THE TIME TAKEN BY VARICOSE ABLATION UNILATERAL?
The procedure takes 45-60 minutes. If you need multiple veins treated in both legs, you may need a number of treatments performed on separate days over a period of 4-6 weeks. After every treatment, you will be wearing your compression stockings for 14 days and walking daily for 30-45 minutes.
WHAT ARE THE RISKS OF VARICOSE ABLATION UNILATERAL?
- EVA is generally complication-free and safe, leaving virtually no scars.
- Injections into the skin can cause skin infection requiring antibiotic treatment and this is seen in less than 1 in 1000 people who have this procedure.
- Some patients may experience significant bruising and tenderness due to the procedure and local anesthetic placed around the vein, which is alleviated by the compression stockings.
- Heat damage to nerves adjacent to the veins is seen in 1 in 150 patients and generally goes away in 3-6 months, but may also be permanent.
- Thrombophlebitis (inflammation, not infection, of the vein) is not uncommon and is seen in 1 in 20 patients, causing pain and redness over the treated area. This generally responds well to ice packs and non-steroidal anti-inflammatory drugs (NSAIDs).
WHAT ARE THE SIGNS AND SYMPTOMS THAT TELLS YOU NEED VARICOSE ABLATION UNILATERAL?
Signs and symptoms of deep vein thrombosis include:
- pain in the leg
- tenderness in the calf (this is one of the most important signs)
- leg tenderness
- swelling of the leg
- increased warmth of the leg
- redness in the leg
- bluish skin discoloration
- discomfort when the foot is pulled upward
WHAT ARE THE BENEFITS OF VARICOSE ABLATION UNILATERAL?
No surgical incision is needed - only a small 2-mm cut in the skin that does not require stitching.
When compared with traditional vein stripping, EVA has fewer complications, is associated with much less pain during recovery and offers a less invasive alternative to standard surgery.
Most of the veins treated become invisible after the procedure, but may take up to 12 months to completely disappear. It is common to have persistent bruising, or yellowish-brown or blue discoloration of the skin around the treated vein for weeks to months after the procedure.
Most patients report relief of their symptoms (such as aching and swelling of the legs, and the appearance of the varicose veins) and are able to return to normal daily activities immediately, with little or no pain.