Endovenous Thermal Ablation

What is endovenous thermal ablation?

Endovenous thermal ablation is a minimally invasive procedure to treat varicose veins. It’s also called endovenous laser or radiofrequency therapy.

Varicose veins are swollen, twisted blood vessels that bulge just under your skin’s surface. These blue or purple bulges usually appear in your legs, feet and ankles.

During endovenous thermal ablation, your provider seals off varicose veins with a laser or high-frequency radio waves. Closing off varicose veins allows healthy veins to restore normal blood flow.

Why is endovenous thermal ablation done?

You might need endovenous thermal ablation if you have medium to large varicose veins in your legs. Varicose veins often look like bulges in the legs that are bluish or skin-colored.

Your blood vessels have one-way valves that move blood toward your heart. Varicose veins develop when these valves become damaged or weak. When valves aren’t working properly, blood can pool in your veins, causing a bulge or swelling that you can see and feel. Symptoms of varicose veins include:

• Achiness.
• Feeling of heaviness in your legs and feet.
• Itching.
• Leg cramps, especially at night.
• Swelling.

Some people have varicose veins removed for cosmetic reasons. After endovenous ablation, varicose veins shrink and blood reroutes to your healthy veins. You won’t be able to see or feel varicose veins after successful treatment.

In other cases, a provider might recommend treating varicose veins because they can cause complications like deep vein thrombosis (DVT), skin sores or bleeding.

Who performs endovenous thermal ablation?

Usually, a vascular surgeon or vascular specialist performs endovenous thermal ablation in an office-based setting.

Is endovenous thermal ablation considered surgery?

Endovenous thermal ablation is a nonsurgical, minimally invasive procedure. This treatment requires a small incision, but it’s much less invasive than varicose vein surgery.

During varicose vein surgery, your surgeon removes the affected veins through several incisions. This type of surgery requires several weeks of recovery.

If you have endovenous thermal ablation, your veins are left in place. It has fewer complications than surgery and your recovery is usually much shorter.

What happens before endovenous thermal ablation?

Before scheduling your procedure, tell your provider about all the medications, vitamins and supplements you’re taking. You may need to stop taking certain medications before your procedure. Your provider will give you detailed instructions on any medication changes you need to make.

Your provider will talk with you about your symptoms and any other health conditions you have.

What happens during endovenous thermal ablation?

Before your procedure, your provider gives you anesthesia to keep you from feeling pain. You’ll receive:

• Local anesthesia to numb the area around your vein.
• Sedative medications to help you relax during your procedure.

During endovenous thermal ablation, your provider will:

• Find your vein with an ultrasound.
• Make a small incision in your leg, usually below your knee or near your ankle.
• Insert a catheter (thin tube) into the incision and guide it into your vein.
• Guide a thin tool into the catheter to your vein. The tool uses a laser or radiofrequency waves to generate heat. This permanently seals off the vein.
• Place a numbing fluid around the vein for anesthesia through a series of small injections.
• Put a bandage over your incision. Most people don’t need stitches.

How long does endovenous thermal ablation last?

Endovenous thermal ablation usually takes one hour. The laser treatment itself takes three to five minutes. It’s usually an outpatient procedure, which means you can go home the same day.

Is endovenous thermal ablation painful?

You’ll receive anesthesia for endovenous thermal ablation, so you won’t feel any pain.

After your procedure, you might experience some soreness, tingling or bruising near the vein that was treated. Usually, you can manage any pain with over-the-counter medications. Ask your provider which pain relief medications are safe for you to use.

What happens after endovenous thermal ablation?

Your provider will tell you how to take care of your incision as it heals. You’ll probably need to:

• Avoid swimming or going in hot tubs.
• Elevate your treated leg when possible.
• Keep your incisions clean and dry.
• Wear compression socks.

After one week of healing, your provider will perform an ultrasound to look at the vein and confirm that it’s sealed.

What are the advantages of endovenous thermal ablation?

Endovenous thermal ablation seals off varicose veins but doesn’t remove them. This means you’ll have a faster recovery time and a lower risk of complications.

Endovenous thermal ablation has several benefits compared to varicose vein surgery, including:

• Less pain.
• Fewer complications.
• Minimal scarring.
• Positive cosmetic results (usually equal to or better than surgery).
• Shorter recovery (you can return to your normal routine sooner).

What are the risks or complications of endovenous thermal ablation?

Endovenous thermal ablation is generally safe when a licensed and experienced provider performs it. Side effects include:

• Bruising.
• Numbness or tingling.
• Pain.
• Blood clots in the legs (this is rare).

If you experience side effects after your procedure, they should get better in a few weeks.

What is the recovery time for endovenous thermal ablation?

After the procedure, you’ll need someone to drive you home. Ask your provider about what you should do to help your body heal. You should:

• Avoid strenuous exercise until your provider says it’s safe to resume physical activity.
• Not fly for two weeks.
• Get adequate sleep to help your body recover.
• Move and walk around frequently during the day.

You should be able to return to work a few days after your procedure. You might need to take some time off work if you have a physically demanding job that requires you to be on your feet all day. Ask your provider when you can return to work.

When should I see my healthcare provider?

Go to the emergency room if you experience any signs of a blood clot, including:

• Chest pain.
• Coughing up blood.
• Fast heart rate.
• Feeling like something is pulling on your calf.
• Lightheadedness or fainting.
• Pain or tenderness that gets worse instead of better.
• Discolored skin.
• Swelling.
• Trouble breathing.

A note from Cleveland Clinic

If you have varicose veins, you don’t have to live with them. Endovenous thermal ablation is one way to get rid of varicose veins without surgery. This procedure can decrease the risk of complications from varicose veins, and can give your legs a smoother appearance.

Choose a licensed and experienced provider. Together, you can select the treatment that works best for you.