Treatment of varicose veins using thermal ablation of the saphenous vein

Treatment of varicose veins when the cause lies in the saphenous vein

At the Varicose Vein Unit at the Publio Cordón Memorial Hospital, thermal ablation of the saphenous vein is used to treat certain forms of venous insufficiency in which this vein ceases to function properly, leading to the development of varicose veins in the legs.

In many people with varicose veins, the problem originates in the saphenous vein, a superficial vein in the leg that can develop venous reflux when its valves cease to function properly. This condition causes blood to pool in the lower limbs, leading to the appearance of visible varicose veins, a feeling of heaviness, swelling or changes in the skin.

Thermal ablation allows the diseased saphenous vein to be closed from the inside, using controlled thermal energy applied via radiofrequency or endovenous laser, two techniques widely used in the modern treatment of saphenous varicose veins. By eliminating the reflux responsible for the problem, blood flow is redirected to other healthy veins that are able to carry the blood back to the heart.

This is a minimally invasive procedure, usually carried out on an outpatient basis and guided by vascular ultrasound.

In which cases is this treatment recommended for varicose veins?

Thermal ablation of the saphenous vein is considered when there is reflux in the saphenous vein, confirmed by Doppler ultrasound, which is responsible for the development or progression of varicose veins in the legs.

When the valves in this vein cease to function properly, blood can pool in the lower limbs and cause symptoms or complications associated with venous disease.

In these cases, the controlled closure of the saphenous vein using endovenous techniques allows the root cause of the varicose veins to be treated, promoting more efficient venous circulation and preventing the condition from worsening.

The need for treatment is always determined following a clinical assessment and an ultrasound scan of the venous system, which confirm whether the saphenous vein is responsible for the reflux.

What benefits can this treatment offer?

The aim of thermal ablation is to remove the vein responsible for the venous reflux that causes many varicose veins, allowing blood flow to be redirected through healthy veins.

When the treatment is appropriately indicated, it is usually associated with:

• A reduction in heaviness or tiredness in the legs

• Improvement in oedema or venous swelling

• A reduced risk of varicose veins progressing

• An improvement in the appearance of visible varicose veins.

Furthermore, as this is a minimally invasive endovenous technique, it avoids traditional varicose vein surgery involving the removal of the saphenous vein.

Diagnosis of varicose veins: venous Doppler ultrasound and specialist assessment

The decision to carry out thermal ablation is always based on a specialist vascular assessment at the Varicose Vein Unit.The key examination is a venous Doppler ultrasound of the lower limbs, a vascular ultrasound scan that visualises the venous system, identifies the affected veins and confirms the presence of reflux in the saphenous vein.

During this examination, venous mapping is also carried out, which enables the procedure to be planned and determines whether the anatomy of the vein is suitable for an endovenous technique. This diagnostic assessment is essential to confirm whether thermal ablation is the most appropriate treatment for varicose veins or whether other therapeutic alternatives should be considered.

How is thermal ablation of the saphenous vein performed?

Thermal ablation of the saphenous vein is a minimally invasive procedure that is usually carried out on an outpatient basis, without the need for hospital admission. In most cases, tumescent local anaesthesia is used, which numbs the area around the vein being treated and allows the procedure to be carried out comfortably for the patient.

Before starting the procedure, the specialist carries out an ultrasound scan of the venous system using Doppler ultrasound, which allows the veins to be visualised in real time and the course of the saphenous vein with reflux to be precisely located.

Through a small puncture in the skin, a very fine catheter or endovenous fibre is inserted into the vein and guided by ultrasound along the segment to be treated. An anaesthetic solution known as tumescent anaesthesia is then injected around the vein; this protects the surrounding tissues and facilitates the controlled application of heat.

Once the catheter is in the correct position, thermal energy is applied using radiofrequency or an endovenous laser. The heat generated causes the vein wall to contract and gradually close, sealing the vessel from the inside. As the diseased saphenous vein closes, blood is naturally redistributed to other healthy veins that are able to carry the blood back to the heart.

Over the course of several weeks, the treated vein ceases to function and is gradually reabsorbed by the body, without adversely affecting circulation in the leg. The procedure usually lasts between 30 and 60 minutes, depending on the extent of the treatment and whether other techniques are combined to treat superficial varicose veins.

In most cases, the procedure is carried out under local anaesthesia alone. In selected situations — for example, when other venous treatments are combined or when the procedure is more extensive — light sedation or regional anaesthesia may be used to improve the patient’s comfort.

Recovery following treatment for varicose veins

Once the procedure is complete, a compression stocking is usually fitted and the patient can get up and walk shortly afterwards. Walking after the procedure is part of the treatment itself, as it promotes venous circulation and reduces the risk of complications.

In most cases, it is possible to resume normal daily activities within one or two days, although it is recommended to avoid strenuous physical activity during the first week. Follow-up care includes clinical check-ups and ultrasound scans to confirm that the treated vein has closed and to assess the progress of the venous system.

Specialist assessment of varicose veins at the Varicose Vein Unit

The decision to perform thermal ablation of the saphenous vein is always made following an individualised assessment of the venous system at the Varicose Vein Unit.

The specialist team analyses the venous anatomy, the cause of the reflux and each patient’s clinical condition to determine whether this procedure is the most appropriate treatment option or whether other complementary techniques should be used.

This approach enables the planning of personalised treatments aimed at addressing the cause of varicose veins and improving the symptoms associated with venous insufficiency.