Endovenous thermal ablation

Endovenous thermal ablation (EVTA) is a minimally invasive surgical procedure used in the treatment of varicose veins. It involves the use of heat generated by radiofrequency or laser energy to seal off affected veins. This technique has gained popularity due to its effectiveness, minimal discomfort, and quick recovery time compared to traditional vein stripping surgeries.

Overview

Endovenous thermal ablation is performed under local anesthesia. The procedure involves the insertion of a thin catheter into the diseased vein through a small incision. The catheter, guided by ultrasound imaging, delivers heat to the vein's wall, causing it to collapse and seal shut. Over time, the treated vein is absorbed by the body, and blood flow is redirected to healthy veins, improving circulation.

Types of Endovenous Thermal Ablation

There are two primary types of endovenous thermal ablation, distinguished by the source of heat used:

• Radiofrequency Ablation (RFA): Utilizes radiofrequency energy to heat the vein.
• Laser Ablation: Uses laser energy to achieve the same effect. Laser ablation is further categorized by the wavelength of light used, with 1470 nm being one of the most effective for vein ablation.

Indications

Endovenous thermal ablation is indicated for patients with symptomatic varicose veins, including those experiencing pain, swelling, leg heaviness, and fatigue, as well as for patients with venous ulcers. It is often recommended when conservative treatments, such as compression stockings, exercise, and elevation of the legs, have failed to provide relief.

Procedure

The EVTA procedure typically follows these steps:

1. An initial consultation and ultrasound examination to map the veins and plan the treatment. 2. Application of local anesthesia to the treatment area. 3. A small incision is made near the affected vein. 4. A catheter is inserted into the vein under ultrasound guidance. 5. The catheter delivers heat to the vein wall, causing it to collapse. 6. The catheter is withdrawn, and the incision is closed.

Recovery

Recovery from endovenous thermal ablation is relatively quick. Most patients can resume normal activities within a day, although heavy lifting and vigorous exercise should be avoided for a short period. Compression stockings are often recommended for a few weeks after the procedure to aid in healing and comfort.

Risks and Complications

While EVTA is generally safe, as with any medical procedure, there are potential risks and complications. These may include skin burns, nerve damage, deep vein thrombosis, and infection. However, the incidence of such complications is low.

Efficacy

Studies have shown that endovenous thermal ablation has a high success rate, with significant improvement in symptoms and quality of life for patients with varicose veins. The procedure has a lower recurrence rate compared to traditional surgical methods.

Conclusion

Endovenous thermal ablation represents a significant advancement in the treatment of varicose veins, offering patients a less invasive option with fewer complications and a quicker return to daily activities. As technology and techniques continue to evolve, EVTA is likely to remain a key treatment modality in phlebology.