Radiofrequency ablation is a minimally invasive procedure commonly used to treat varicose veins. A device resembling a straw is inserted into the leg alongside the vein. A thin fibre is then inserted through the straw into the vein where it is heated, causing it to collapse and seal off. Once treated, the vein will gradually undergo complete reabsorption by the body and disappear over time.
The advantages of radiofrequency ablation include that it is considered the gold standard in varicose vein treatment, it is a quick procedure, it is minimally invasive, causes very little pain or discomfort, and has exceptional success rates.
Radiofrequency ablation is a safe and simple procedure that begins with an incision around the knee or the middle of the calf. A popper straw is inserted into the underlying vein, beneath the superficial vein system. A heating fibre is then inserted inside the straw and continues until it nears the end of the superficial vein system.
Although performed under general anaesthetic, a dose of cooling local anaesthetic is injected around the vein to protect the surrounding tissue before the fibre is heated. The vein is sealed by the heated fibre through quarterisation in seven-centimetre segments. Depending on how many veins you are having treated, the procedure can take between 45 minutes to one and a half hours. The procedure is a safe and relatively pain free experience.
While rare, possible complications may include:
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.
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.
Some patients may experience bruising and tenderness due to the procedure and local anaesthetic placed around the vein, which is alleviated by the compression stockings.
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.
Deep vein thrombosis (DVT) is seen in 1 in 400 patients, with the risk of developing a DVT returning to normal in 2–4 weeks. Blood clots that form in the veins can travel to the lungs (pulmonary embolism), although this is an extremely rare occurrence that happens in less than half of the people who develop a DVT.
If you are scheduled for surgery in the morning, please do not eat or drink anything from midnight the night before your operation. If you are scheduled for surgery in the afternoon, you can have a normal breakfast at 7am the day of your surgery; however, you cannot eat or drink anything after your breakfast.
If you are taking regular medications (aka – blood pressure, heart disease, contraction pill) please continue to take them with a sip of water even when fasting.
If you are a diabetic, you should halve the dose of your normal medications the night before and do not take any diabetic medication prior to surgery.
If you are taking Aspirin or Plavix, please take it prior to surgery. If you are taking Warfarin or another anticoagulant such as Dabigatran (Pradaxa) or Rivaroxaban (Xarelto) please speak to your doctor for further advice.
You will be provided with compression stockings on the day of your surgery.
If you have a hard copy, please bring any recent imaging you have had done to the surgery. If you have had your imaging done under the care of Doctor Cohen, you will not need to bring anything with you as he will have digital access on the day.
What to do when you arrive at hospital
When you arrive at the hospital please proceed to Surgical Admissions where the team will help direct you to the preoperative area where you will be asked to change out of your clothes and into a theatre gown.
A nurse will shave your leg prior to the surgery. Doctor Cohen will ask you to stand for a while to allow the varicose vein in your leg to become more prominent. He will then draw markings on your leg to outline the veins being targeted in the surgery.
What to expect immediately after surgery
Your legs will be tightly bandaged from the foot to the upper thigh to help reduce swelling and minimise bruising. Once you have been returned from theatre, you will be encouraged to get out of bed and walk around. The first time you do this, it is likely you will feel lightheaded and dizzy. If this occurs, hang your legs over the edge of the bed until the feeling passes. The nursing staff will be able to help you as well.
The nurse will remove your bandages and glue any spots that may require attention, and will place your compression stockings on before you leave the hospital.
There will likely be bruising down the inner thigh, knee, and lower leg. This will resolve itself in due course. If you do get bleeding, let the nursing team know and they will put waterproof dressing over the site.
If needed for pain, you can take Panadol or Nurofen.
You will need to have a post-operative ultrasound to ensure the vein has been closed off and the other veins in your leg are working well.
The nursing staff will help you put your compression stocking on. It will need to remain on 24-hours a day for three days. If the stocking causes you significant discomfort you can remove it, but please contact Doctor Cohen’s office to let them know.
You can remove the stocking when you shower. Please place it back on afterwards.
After the first three days, you can remove the stocking before going to bed, but you will need to put it back on in the morning. You will need to wear the stocking for two weeks during the day, a total of three days and two weeks.
Doctor Cohen will recommend you remain active by walking 30 minutes twice a day. For those who can do so, you can return to the gym, running, yoga, cycling, etc – in seven to 10 days if you are feeling well. You must avoid swimming for the first three weeks. For other activities, you can remove the stocking and wear active wear for compression. You must put the stocking back on once you have finished exercise.
Returning to work
Most patients can return to work in four to five days. If you need a certificate for work, please speak to Doctor Cohen.
You can return to driving once you are completely pain free. This is usually 24-48 hours post-surgery.
Certificates for follow-up
Following your discharge please speak to Doctor Cohen’s administration team to book a follow up appointment. This will usually be four to six weeks post-surgery.
Bleeding – if you get a small bleed simply place a finger on the site, apply pressure, and elevate the leg for 10 minutes. Place a band aid over the site. This may happen from time to time and will not affect your recovery. If you are concerned, call Doctor Cohen’s office.
Lump under the skin – during the first week you will likely notice a lump under the skin along the line of the old vein, and underneath the small incision from the knee to the ankle. This is a result of old blood beneath the skin and will improve over time as the body absorbs it.
Pulling sensation – some people will experience a pulling sensation down the inside of the thigh. This is due to the heating of the vein and will improve over time.
Tenderness – approximately one week after surgery you may experience tenderness along the inside of your thigh. This is due to inflammation of the vein and will improve with time. You can also take a mild anti-inflammatory medication such Nurofen.
Infection – if the area around the wound is red, please contact Doctor Cohen. While rare, all surgery has a risk of infection. Simple measures such as the application of Betadine and other antiseptics can help.
Bruising underneath the compression stocking – if you do have significant bruising and inflammation under the stocking, you can purchase Hirudoid Cream from the pharmacy and apply twice a day.