Patient education: Vein ablation (The Basics)

What is vein ablation? — Vein ablation is a procedure that is used to treat different types of vein disease. It works by sealing up or removing a diseased vein, so that blood cannot flow through it anymore. The blood that would normally flow through that vein finds another route back to the heart.

Vein ablation is done only to people who have not gotten better with simpler treatments.

Vein ablation can be done a few different ways:

●Thermal ablation – For thermal ablation procedures, the doctor inserts a thin tube called a "catheter" into the diseased vein. The tip of the catheter heats up the vein and seals it from the inside as it is slowly removed (figure 1). The vein stays in place, but it no longer carries blood.

Radiofrequency ablation and laser ablation are both types of thermal ablation. These procedures involve only a small hole or cut in the skin. They are done using a special kind of local anesthesia (medicine injected under the skin to block pain) called "tumescent anesthesia." These procedures can often be done in a doctor's office.

●Nonthermal ablation – For nonthermal ablation, the doctor injects a chemical or glue, inserts a wire, or uses a combination of these into the diseased vein. One combination that is used is called "mechanochemical ablation" or "MOCA." This causes the vein to collapse on itself. The vein stays in place, but it no longer carries blood. Nonthermal ablation can be done in a doctor's office with local anesthesia (medicine to numb the area so the injection won't hurt).

Nonthermal ablation does not require tumescent anesthesia.

●Vein ligation or stripping – These procedures involve surgery to remove the diseased vein or veins. People who have these procedures must have anesthesia. The procedures might be done in a hospital, surgery center, or doctor's office, depending on the size and number of veins. Veins are removed through small cuts in the skin.

Can I choose which procedure to have? — Often, yes. Your doctor will recommend which types of procedure would work for the type of vein problem you have. If there is a specific procedure you want to have, let your doctor know.

How do I prepare for vein ablation? — That depends on which procedure you will have. Your doctor will give you detailed instructions about what to do before your procedure.

In general, people having nonthermal or thermal ablation might be offered a pill to help calm them before the procedure. Some people have to stop taking certain medicines before the procedure, but that is not common. People having vein ligation or stripping have a different preparation, because these procedures involve surgery.

What happens after vein ablation? — After having a vein ablation procedure, most people are asked to:

●Walk around for a few minutes multiple times a day

●Avoid sitting or standing for too long

●Prop up their leg while sitting (for example on pillows)

●Avoid heavy lifting or exercise for 1 to 2 weeks after the procedure

Depending on the type of ablation procedure you have, you might be asked to wear special bandages or stockings called "compression bandages" or "compression stockings." These bandages or stockings will put steady pressure on your leg and can help prevent bruising.

Also depending on what type of procedure you have, you might have to go back to the doctor a few days after your procedure for a test called an ultrasound. This is to make sure you have not developed any blood clots in your leg. It is very important to get this test if your doctor tells you to.

What problems can happen after vein ablation? — The problems that can happen are different for the different procedures. In general, the problems can include:

●Blood clots in the legs

●Bleeding under the skin that forms a soft lump called a "hematoma"

People who have ablation procedures can also have:

●Wound infections

●Nerve damage

Over time, it's possible for a vein that has been sealed to open back up again. This is uncommon with thermal ablation procedures, but has happened. With vein ligation or stripping, the diseased vein is gone, but sometimes other veins in the area become diseased.

When should I call my doctor or nurse? — Call your doctor or nurse right away if:

●You wear bandages or stockings and notice signs that they might be too tight – For example, they might be too tight if your leg or foot tingles or feels cool, or if the toes on the treated side turn white or purple. You can remove the bandages or stockings if this happens, but call your doctor or nurse, too.

●You have intense pain or swelling that does not get better with the pain medicines your doctor prescribed – These symptoms could be a sign that you have a clot in your leg.

●You bleed through your bandages even after the doctor has adjusted them, or you bleed and soak your bandages.

More on this topic

Patient education: Varicose veins and other vein disease in the legs (The Basics)
Patient education: Superficial vein phlebitis and thrombosis (The Basics)
Patient education: Duplex ultrasound (The Basics)
Patient education: Deep vein thrombosis (blood clot in the legs) (The Basics)
Patient education: Endovascular surgery (The Basics)

Patient education: Lower extremity chronic venous disease (Beyond the Basics)
Patient education: Deep vein thrombosis (DVT) (Beyond the Basics)