What are the recommended instructions for post Great Saphenous Vein (GSV) Radiofrequency Ablation (RFA)?

Post-GSV Radiofrequency Ablation Instructions

Immediate Post-Procedure Monitoring

Patients must be monitored for at least 2 hours in the recovery room with clear written instructions provided regarding fluids, diet, and medications. 1

• Monitor vital signs including blood pressure, heart rate, electrocardiogram, and oxygen saturation during the recovery period 1
• Observe specifically for bleeding, localized swelling, nausea, vomiting, and any signs of complications 1
• Ensure patients are tolerating water well before discharge 1

Mandatory Early Duplex Ultrasound Surveillance

Early postoperative duplex ultrasound scanning is essential and should be mandatory in all patients undergoing RFA of the GSV, performed within 2-30 days (ideally 7-10 days) after the procedure. 2, 3

• This early imaging is critical because deep venous thrombosis (DVT) occurs in approximately 13-16% of patients after GSV RFA 2, 4
• Thrombus protrusion into the common femoral vein occurs in 2.5-8% of cases 3, 4
• The duplex scan should specifically assess for GSV occlusion, thrombus extension beyond the saphenofemoral junction, and any DVT in the deep venous system 2, 3

Compression Therapy Protocol

Medical-grade gradient compression stockings (20-30 mmHg minimum) should be prescribed immediately post-procedure. 1, 5

• For more severe disease manifestations, pressures of 30-40 mmHg are advised 1
• Compression should be worn continuously for the first 48-72 hours, then daily during waking hours 1
• Inelastic compression provides better outcomes than elastic bandaging for wound healing in C5-C6 disease 1

Activity Modifications and Return to Normal Function

Patients typically return to normal activities within 3 days (median 2-5 days) after RFA, significantly earlier than conventional surgery. 6

• Encourage regular leg elevation and ambulation to prevent thrombotic complications 5
• Implement an exercise program focusing on calf muscle pump activation 5
• Avoid prolonged standing or sitting for extended periods during the first 2 weeks 5

Warning Signs Requiring Immediate Evaluation

Patients must receive contact information for the on-call team and be instructed to seek immediate care if they develop chest pain, breathlessness, fever, tachycardia, or become unwell. 1

• Suspect DVT or pulmonary embolism when patients develop persistent chest pain, breathlessness, fever, or tachycardia 1
• Transient chest pain is not uncommon following ablation, but persistent pain should prompt immediate CT scan with oral contrast 1
• Perform endoscopic re-inspection or vascular imaging if the patient becomes symptomatic to assess for thrombotic complications 1

Pain Management Expectations

Post-procedure pain after RFA is significantly less than conventional surgery, with median visual analogue scale scores of 1.70 versus 4.0. 6

• Most patients require minimal analgesic therapy 6
• Excessive pain occurs in approximately 4-8% of patients and may indicate complications 3
• Superficial thrombophlebitis occurs in approximately 1-2% of cases and can be managed conservatively 3

Follow-Up Imaging Schedule

After the mandatory early duplex scan at 7-10 days, perform follow-up ultrasound at 2-3 months to assess for complete GSV occlusion and evaluate persistent varicosities. 7

• GSV occlusion rates of 91-100% are expected within 1 year after RFA 1
• Approximately 25% of patients may require subsequent stab phlebectomy for persistent symptomatic varicosities at 2-3 months 7
• In 65% of cases, symptoms resolve completely without further therapy 7

Anticoagulation Management for Thrombotic Complications

All patients with thrombus extension into the common femoral vein or DVT must receive standard anticoagulation therapy. 2, 3

• Treatment typically consists of enoxaparin, which can be administered on an ambulatory basis for most patients 2
• Patients with floating thrombus in the common femoral vein may require hospital admission 2
• Inferior vena cava filter placement should be considered only for floating thrombus with high embolic risk 2, 3
• Follow-up duplex scans at 12-14 days typically show resolution of thrombus protrusion 3

Risk Factors for Thrombotic Complications

Larger GSV diameter (>8-10 mm), previous superficial thrombophlebitis, and concomitant phlebectomy procedures significantly increase the risk of acute thrombotic events. 4

• GSV diameter >10 mm increases AT event risk (mean 1.1 cm vs 0.93 cm in those without complications) 4
• Previous superficial thrombophlebitis increases AT risk from 11% to 27% 4
• Concomitant venous operations increase AT events from 9% to 23% 4
• Patients >50 years old may benefit from DVT prophylaxis consideration 3

Common Pitfalls to Avoid

• Never skip the early postoperative duplex scan—this is the most critical safety measure, as thrombotic complications are common and potentially life-threatening 2, 3
• Do not perform routine contrast studies unless patients develop warning symptoms—imaging should be symptom-driven after the mandatory early duplex 1
• Avoid treating branch varicosities immediately—reassess at 2-3 months as 65% of patients have complete symptom resolution without additional procedures 7
• Do not discharge patients before ensuring they tolerate oral fluids—this prevents dehydration-related thrombotic complications 1