The lynchpin treatment for varicose veins is endovenous ablation. Let’s define the term: “endo” means inside; “venous” means related to the vein; “ablation” means to remove or destroy. So “endovenous ablation” basically translates into “destroy the vein from the inside”.
Remember that the anatomy of superficial veins of the leg is like an upside-down tree. The trunk of this tree is the Greater Saphenous Vein, or GSV, a long, straight vein that runs along the inside of the thigh.
The branches of the tree are the small veins under the skin. When valves in the GSV are damaged, blood flows the wrong way–down the leg instead of up toward the heart–and the small branches, which are usually not visible, grow and bulge under the skin as varicose veins.
A similar structure exists below the knee. The major trunk is the Lesser Saphenous Vein, or LSV, which runs along the calf.
Unless the reflux in the major trunks (GSV, LSV) is treated, the small branches won’t go away. So the first step in treating varicose veins generally consists of endovenous ablation: destroying the vein from the inside. Endovenous ablation involves placing a small probe inside the vein at the level of the knee, sliding it up to where the trunk begins, and sliding it back down as the tip of the probe burns the inside of the vein.
Well…it’s slightly more involved than that, but not by much. Here is the more detailed version of the procedure:
- The skin of the leg is cleaned and a sterile workspace is created.
- The doctor gives a numbing shot near the knee where the probe will enter the vein.
- While watching under ultrasound, the doctor puts a needle into the vein. The doctor exchanges the needle for the probe which looks like a long plastic tube. Using the ultrasound to guide the path of the probe, the doctor slides the probe up the vein close to its origin at the top of the thigh.
- In order to both numb and insulate the area around the vein, a solution of saline mixed with a local anesthetic is injected all around the vein along its entire length. This part usually involves a few more numbing shots to the skin itself which sting for a few seconds.
- The doctor turns on whatever technology is being used to do the ablation–laser or radiofrequency–and slides the probe back along the length of the vein. This part only takes a minute or two.
- The probe is removed and bandages are placed on the leg at various places. A compression stocking is then placed on the leg.
What happens after the procedure?
Generally, you need to wear the compression stockings for a fixed length of time. Here at VIP, we have our patients wear the stockings around the clock for 3 days, and then 12 hours a day for another 11 days.