From the Guidelines
Saphenous vein ablation is a minimally invasive medical procedure used to treat varicose veins by closing off damaged veins that are causing symptoms, and it has largely supplanted surgical ligation and stripping as the main invasive method to treat varicose veins with similar efficacy, improved early QoL, and reduced hospital recovery 1.
Overview of Saphenous Vein Ablation
The procedure involves inserting a thin catheter into the affected saphenous vein (typically the great or small saphenous vein in the leg) and using heat energy to seal it shut. This can be accomplished through several techniques including radiofrequency ablation, which uses electrical energy to heat the vein wall, or endovenous laser treatment, which uses laser energy.
Key Points
- Local anesthesia is used during the procedure, which typically takes 30-60 minutes to complete 1.
- After ablation, blood naturally reroutes through healthier veins, improving circulation.
- Patients usually wear compression stockings for 1-2 weeks following the procedure and can typically return to normal activities within 24-48 hours.
- The procedure effectively treats symptoms like leg pain, swelling, and skin changes caused by venous insufficiency.
- Ablation has largely replaced traditional vein stripping surgery because it offers similar effectiveness with faster recovery times, less pain, and minimal scarring.
- Potential side effects include bruising, temporary numbness, skin burns, blood clots, or infection, though serious complications are rare.
Treatment Options
- Radiofrequency ablation (RFA) and endovenous laser ablation (EVLA) are the two types of endovenous ablation, with occlusion rates varying from 91% to 100% within 1-year post-treatment 1.
- Multiple recent meta-analyses confirm that EVLA and RFA are at least as efficacious, if not slightly more so, than surgery 1.
Recommendations
Based on the most recent and highest quality study, saphenous vein ablation is recommended as a first-line treatment for nonpregnant patients with symptomatic varicose veins and documented valvular reflux 1.
From the Research
Definition of Saphenous Vein Ablation
- Saphenous vein ablation is a minimally invasive medical procedure used to treat varicose veins and venous insufficiency in the legs 2, 3, 4.
- The procedure involves the use of laser or radiofrequency energy to heat and close off the affected vein, thereby preventing blood from flowing through it and reducing symptoms such as pain, swelling, and discoloration 2, 3, 4.
Types of Saphenous Vein Ablation
- Endovenous laser ablation (EVLA) is a type of saphenous vein ablation that uses laser energy to close off the affected vein 2, 3, 4.
- Radiofrequency ablation (RFA) is another type of saphenous vein ablation that uses radiofrequency energy to heat and close off the affected vein 5, 6.
- Ultrasound-guided foam sclerotherapy (UGFS) is a minimally invasive procedure that uses foam to close off the affected vein, but its effectiveness compared to EVLA and RFA is still uncertain 5.
Effectiveness and Safety of Saphenous Vein Ablation
- Studies have shown that saphenous vein ablation is an effective treatment for varicose veins and venous insufficiency, with high success rates and low complication rates 2, 3, 4, 6.
- The procedure is generally safe, with few reported complications such as nerve injury, wound infection, and deep vein thrombosis 2, 3, 5, 4, 6.
- Saphenous vein ablation has been shown to improve symptoms and quality of life for patients with varicose veins and venous insufficiency, with significant reductions in pain, swelling, and discoloration 2, 3, 4, 6.