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Endovenous Thermal Ablation Video Explained

Endovenous thermal ablation (EVTA) is the most common approach to treatment of an incompetent great saphenous vein. It is not feasible to repair the many failed valves in the incompetent vein, so treatment involves sealing the vein shut so it will no longer allow blood to flow downward with gravitational force when one is sitting or standing. Vein stripping, a surgical technique that involves pulling the vein out of the leg, usually under general anesthesia, is much more traumatic than endovenous thermal ablation. EVTA provides better results, involves fewer complications, causes consistently less post-operative discomfort, and is much less expensive than surgical stripping.

Most of our patients take an oral anti-anxiety drug and a pain tablet about one hour prior to the procedure. Some choose instead to take a non-sedating non-steroidal anti-inflammatory drug such as naproxen or ibuprofen and they do quite well. The discomfort during the 30-40 minute procedure is brief and is related to placement of local anesthetic at the skin puncture sites and around the vein to be treated. Many of our patients comment that their discomfort is less than that of a visit to their dentist.

We encourage our patients to walk frequently after the procedure and to return to most normal daily activity including most work activity the following day. Many of our patients are school teachers and nurses who nearly always return to work on Monday after procedures on the previous Thursday and Friday. We see the patient back for a brief ultrasound exam and office visit during the week after the procedure.

Some ask how the venous blood gets out of the leg after the EVTA. The deep veins inside the muscles carry about 90% of the venous blood out of the leg. A vein which is incompetent allows blood to flow with gravity toward the ankle rather than toward the heart. The deep veins become overloaded by the downward leak of blood in the incompetent superficial veins (due to failed valves). Sealing the leaking saphenous veins shut actually improves venous flow out of the leg by reducing the overload on the deep veins.

Our video shows EVTA of the great saphenous vein with radiofrequency (RF). The only RF catheter approved for EVTA in the US is made by VNUS and has been called the “Closure” device. VNUS recently changed the name to the “Venefit” device. The procedure may be performed in a very similar fashion with LASER instead of RF to seal the vein closed. Results are similar with either technology with very rare failure to seal the vein closed. The Venefit procedure has been shown to cause less discomfort after the procedure than LASER, though some of the newer LASERs may be similar to the Venefit procedure in terms of post-op discomfort. Most of our patients use naproxen or ibuprofen (non-narcotic pain relievers) after the procedure and do not need narcotics.

The video shows ultrasound of the incompetent great saphenous vein including a leaking valve followed by needle stick placement of an intravenous sheath and the Venefit catheter into the vein. Local anesthetic is then placed surrounding the vein to be treated with ultrasound guidance. The actual treatment usually takes about 3 minutes and is painless. Upon completion of the procedure, a light dressing is applied and the patient is placed in thigh-length elastic support hose and an elastic wrap. The leg is kept elevated for 15 minutes before we discharge the patient home.

EVTA Procedure In Detail

Endovenous thermal ablation (EVTA) utilizes very controlled heat inside the vein to seal the vein shut. Most patients take a small dose of oral pain medication and a mild sedative one hour prior to the procedure and the procedure is performed in the office with local anesthesia. With ultrasound guidance, a tiny needle is inserted into the vein to be treated and a small catheter (tube) is passed up the vein. A local anesthetic is injected with ultrasound guidance into the tissues surrounding the vein to be treated in order to numb the vein and to absorb the heat from the device. The actual treatment of the vein typically lasts 2 to 3 minutes and causes no pain. The entire procedure from application of skin antiseptic to placement of a small dressing usually lasts 30 to 40 minutes. The skin incision is 2 to 3 mm (less than 1/8 inch) long. This technique is more than 99% successful in sealing shut the leaking (incompetent) saphenous vein with minimal discomfort, minimal risk, and at a small fraction of the cost of traditional vein stripping which was developed over a hundred years ago.

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