Tag: treatment

Varicose Vein Procedures: Endovenous Thermal Ablation

Endovenous Thermal Ablation

The first procedure typically performed is the venous ablation. This is where the vein is burned with either laser or radio frequency catheters. During this procedure, the patient is sedated with valium, nitrous oxide, or both. The patient can choose the level of sedation they prefer.

During this procedure, the sonographer will map the vein to be ablated and mark a location that appears to be a good access point. What we look for is whether the vein is straight and has a large diameter, which makes accessing the vein easy. Veins will sometimes spasm or be a smaller diameter early in the morning when the patient hasn’t been standing or active all day, or when the leg is cold. In these cases, we use gravity, a Nitroglycerin patch, and a blanket to help warm up the leg and increase the diameter of the vein.

Once a location is marked, we prep the leg with a cleansing/sterilizing solution and set up the procedure using sterile technique. We ask that the patient not touch the sterile field, so to prevent infection. When the physician enters the room, he will also dress in a sterile gown and will don sterile gloves. We take every precaution to keep the patient safe and infection free.

At this point, the physician will access the vein and start the procedure. Once the vein is accessed, a “guide” wire is inserted and the sonographer will follow the wire up the vein to make sure we are in the vein and not in the surrounding tissue. After that, the catheter, with the heating element, is inserted and once again the sonographer follows the catheter with ultrasound to make sure it is in the vein to be treated.

Once the catheter is an acceptable distance from the deep venous system, we need to numb around the vein. This is two-fold: The first reason is to numb and protect the tissue surrounding the treated vein from being burned. The second is to compress the vein around the catheter so the walls of the vein will be treated.

Once this all complete, the catheter is slowly removed and the vein will be ablated. We close the access point with steri-strips and the procedure is finished. The patient is then required to wear a compression stocking for one week.

Varicocele Treatment Options

In the United States, varicocele treatment has traditionally involved open surgery, usually performed by a urologic surgeon, or urologist. In recent years however, a safe and effective non-surgical alternative called varicocele embolization is becoming the treatment of choice for many patients and their physicians

Varicocele embolization is an outpatient procedure that is performed without general anesthesia using light sedation. In this type of varicocele treatment, a small tube is inserted into the neck or groin through a small nick in the skin (about the size of the lead in a pencil). The skin is numbed for this procedure and it is not painful. Next a small catheter, or tube, is painlessly guided up into the abdomen and into the varicocele vein under the guidance of x-ray imaging. A dye is injected to create an x-ray map (venogram) of the vein and tiny metal coils or other embolizing substances are inserted through the catheter to block the flow of blood to the vein. The tube is removed and no stitches are needed. Patients are observed for a few hours and go home the same day. Recovery from varicocele embolization typically takes less than 24 hours and patients often return to work the next day.

Advantages of Varicocele Embolization

The majority of men in the United States undergo surgery as varicocele treatment. This is because they are usually sent to surgeons for evaluation, and many do not know about varicocele embolization. The advantages of this alternative, interventional radiology varicocele treatment include:

  • It is as effective as surgery, as measured by improvement in semen analysis and pregnancy rates.
  • It does not require any surgical incision in the scrotal area.
  • A patient with varicoceles on both sides can have both fixed at the same time through one vein puncture site (surgery requires two separate open incisions).
  • General anesthesia is not used for embolization (most surgery is done under general).
  • There is a lower rate of complications compared to surgery. Infection has not been reported after embolization.
  • It requires less recovery time. Post embolization patients are virtually never admitted to the hospital. Even patients with physically demanding jobs may return to work within the next day or two, unlike post surgical patients.
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Is it safe to close down veins? Don’t you need those veins?

Often times when we are talking to patients about closing down their problematic varicose veins we will get asked “are you sure you can close down those veins?” or “doesn’t my body need those veins, are you going to make things worse?”

When treating varicose veins we explain to patients that we are treating superficial veins and these veins only return 10% of the blood from the legs. The remaining 90% is returned through the deep system. We are not treating or closing down any deep veins, in addition, there are so many remaining superficial veins that are still working properly that we close down the problematic ones and improve symptoms in you legs.

Another question asked often is “What is the limit to how many veins you can close down without causing a problem?” That is a difficult question to answer, but so far we have not reached an upper limit in treating varicose veins where we would feel that treating anymore veins may create problems instead of solving them.