Radiofrequency ablation (RFA) for varicose veins

What is radiofrequency ablation for varicose veins?

Radiofrequency ablation (RFA) for varicose veins is a minimally invasive endovenous treatment for varicose veins caused by reflux in a superficial truncal vein, usually confirmed on duplex ultrasound. It uses radiofrequency heat energy to close the faulty vein from the inside. Blood then naturally redirects through healthy veins, and the treated vein gradually shrinks and is absorbed by the body.

It is usually performed as a day-case procedure under local anaesthetic, with a small puncture rather than a surgical incision. Most people are able to walk immediately afterwards and return to light normal activities quickly, although some bruising, tightness or tenderness is common.

What is radiofrequency ablation also known as?

Radiofrequency ablation is also referred to by its acronym, RFA. You may also hear it called endovenous radiofrequency ablation, endovenous thermal ablation, VNUS closure or ClosureFast, depending on the system used.

What are varicose veins?

Varicose veins are large, sometimes twisted veins that most often occur in your leg. They occur when the valves that control blood flow in your legs become weak and don’t close properly, enabling blood that should be flowing in one direction to flow back into them. The blood pools, causing the veins to become larger and develop bulges that enable them to be seen under your skin.

You’re more likely to develop varicose veins if you’re overweight or pregnant. They also run in families and are more likely to affect women than men.

What are the symptoms of varicose veins?

The most common symptoms of varicose veins include:

• Visible purple, bulging, lumpy veins
• Changes in skin colour
• Skin ulcers
• Aching or heaviness in your legs
• Itchy or burning feeling in the skin over your veins
• Restless legs
• Swollen feet and ankles
• Cramps in your legs, usually at night.

Can varicose veins be dangerous if left untreated?

Although many people consider them to be a cosmetic issue because of the way they look, varicose veins can also cause medical problems if left untreated, including skin changes, eczema, superficial thrombophlebitis, spontaneous bleeding and venous leg ulcers.

Who is suitable for radiofrequency ablation for varicose veins?

You may be a good candidate for radiofrequency ablation if your duplex ultrasound scan shows reflux in a suitable superficial truncal vein and your varicose veins are causing symptoms such as aching, heaviness, swelling, itching, skin changes, bleeding or superficial thrombophlebitis.

Some people choose to have treatment for cosmetic reasons, although NHS treatment is usually reserved for clinical indications. Your consultant will assess your symptoms, examine your legs and review your scan before advising whether RFA is appropriate for you.

Who may not be suitable for radiofrequency ablation for varicose veins?

You may not be suitable for radiofrequency ablation for varicose veins if you:

• Are pregnant, or have recently been pregnant. Elective treatment is usually deferred until after pregnancy; breastfeeding patients should discuss timing and medication issues with their consultant
• Have significant arterial disease affecting the leg
• Have active deep vein thrombosis, or have a blood clotting disorder that requires individual specialist assessment
• Have an active skin infection
• Have severe peripheral arterial disease or poor circulation to the foot
• Have significant mobility issues, because walking after treatment is important to reduce the risk of complications
• Have veins that are very tortuous, heavily scarred, too close to the skin surface, or otherwise unsuitable for safe catheter treatment.

What are the alternatives to radiofrequency ablation for varicose veins?

There are several different alternatives to RFA treatment for varicose veins.

Radiofrequency ablation vs endovenous laser ablation for varicose veins

Radiofrequency ablation and endovenous laser ablation are both heat-based treatments that close off the faulty vein. The main difference is the energy source that they use. RFA uses radiofrequency energy, while EVLA uses laser energy.

Radiofrequency ablation vs foam sclerotherapy for varicose veins

Radiofrequency ablation and foam sclerotherapy are both minimally invasive treatments for varicose veins, but they work differently. RFA uses heat to close the faulty vein, while foam sclerotherapy uses an injection to make the vein collapse and seal shut. RFA is usually better for larger main veins, while foam is often used for smaller veins or as an option when a heat-based treatment is not suitable.

What are the surgical alternatives to radiofrequency ablation for varicose veins?

The main surgical alternative to radiofrequency ablation is vein stripping and ligation, where the faulty vein is tied off and removed through small cuts. RFA closes the vein from the inside using heat, while surgery removes the vein altogether, although RFA is usually less invasive, with less scarring and a quicker recovery.

How can I prepare for radiofrequency ablation for varicose veins?

As a minimally invasive day-case procedure, getting ready for radiofrequency ablation is usually straightforward. You will be advised to follow any instructions from your clinical team about eating, drinking and regular medication, especially blood-thinning medication.

It is sensible to be well hydrated and to avoid alcohol before your appointment. You may wish to have a shower before you arrive, as you will usually be asked to keep the dressing dry for at least 24 hours afterwards. Do not apply moisturiser to the treatment area and do not shave the area unless specifically asked to.

You should arrange for someone to take you home after your appointment. RFA is usually performed using local anaesthetic, which does not normally cause drowsiness, but your leg may feel numb or uncomfortable afterwards. You must not drive if you have had sedation, if your leg is numb, or if you cannot safely perform an emergency stop.

Will I need a duplex ultrasound scan before radiofrequency ablation?

Yes. A duplex ultrasound scan should be performed before treatment to confirm the diagnosis, identify reflux in the superficial veins, assess whether RFA is suitable and help plan the procedure. This is consistent with NICE guidance for assessment and treatment of varicose veins.

What happens during radiofrequency ablation for varicose veins?

The procedure is performed using ultrasound guidance. Your consultant will mark the veins being treated and clean the skin. Local anaesthetic is injected, and a small puncture is made to place a thin catheter into the faulty vein. Tumescent local anaesthetic is then placed around the vein to numb the area, protect surrounding tissues and improve contact between the vein wall and the catheter.

The catheter delivers radiofrequency heat energy in controlled segments, closing the vein from the inside. The catheter is then removed and a dressing and compression stocking or bandage are applied.

How long does radiofrequency ablation for varicose veins take?

The treatment itself often takes around 30 minutes, but you should expect the full appointment to take longer to allow for preparation, ultrasound marking, local anaesthetic, dressings and recovery.

Is radiofrequency ablation for varicose veins painful?

RFA should not be very painful because local anaesthetic is used to numb the treatment area. You may feel pressure, tugging, warmth or stinging from the local anaesthetic injections, but you should not feel significant pain during the ablation itself. Tell your clinical team if you are uncomfortable.

Will I need more than one radiofrequency ablation treatment?

It depends on how many veins need treating and whether both legs are involved. One RFA session is usually enough to close the treated truncal vein, but visible surface varicose veins may need additional treatment, such as phlebectomies or foam sclerotherapy. This may be performed at the same appointment or arranged separately. Your consultant will explain your personal treatment plan.

How long does it take to recover from radiofrequency ablation for varicose veins?

Recovery is usually quick: most people go home the same day and can return to light normal activities within 24 to 48 hours.

Mild soreness, bruising, tenderness, lumpiness or tightness along the treated vein can happen at first and may last for a few weeks. Compression stockings and regular walking are often recommended, but the exact duration of compression varies depending on your treatment and your consultant’s advice.

When can I return to work after radiofrequency ablation for varicose veins?

It depends on the type of work you do. If you have a desk job, you can probably go back to work within 24 hours. However, if you have a role that is more physically demanding, you may need to take a few days off. Always follow the recommendation of your medical team.

When can I exercise after radiofrequency ablation for varicose veins?

Although you may feel fine after your RFA treatment for varicose veins, you can’t get back to intense physical exercise right away. Circulation is important, so you’ll be advised to start gentle walking straight away, but any high-impact, strenuous workouts or any heavy lifting should be avoided for at least a week or more. Again, always follow the instructions of your Nuffield Health medical team.

When can I shower after radiofrequency ablation for varicose veins?

You’ll be advised to keep the area dry for at least 24 hours.

When can I drive after radiofrequency ablation for varicose veins?

You should not drive immediately after RFA. You can drive again when your leg is comfortable, any numbness has worn off, you are not taking medication that affects driving, and you can safely perform an emergency stop. If you have had sedation, you must not drive for at least 24 hours and should follow the instructions given by your clinical team.

When can I fly after radiofrequency ablation for varicose veins?

Flying can increase the risk of blood clots, particularly on longer journeys and in people with additional risk factors. The safest timing after RFA depends on your individual risk, the extent of treatment, and whether you have had previous DVT, thrombophilia, cancer, obesity, reduced mobility or other risk factors. Ask your consultant before booking air travel, especially long-haul travel.

What are the benefits of radiofrequency ablation for varicose veins?

Some of the benefits of choosing RFA treatment for varicose veins include:

• High success rate: Studies show that radiofrequency ablation has a high technical success rate for closing the treated truncal vein. Long-term results are also favourable, but success figures usually refer to the closure of the treated vein rather than the complete removal of every visible varicose vein or the prevention of new varicose veins in the future.
• Minimally invasive treatment: As a minimally invasive treatment, there’s no need for a general anaesthetic or large incisions (like those seen in vein-stripping). Instead, a tiny needle is inserted through the skin, leaving virtually no wound at all.
• Fast recovery: With such a minimally invasive technique, recovery is usually faster than with traditional vein stripping. Many people return to light daily activities within 24 to 48 hours, but strenuous exercise and heavy lifting should usually be avoided for a short period as advised by your clinical team.
• Less pain and bruising: Again, the minimally invasive nature of this technique means that there’s far less discomfort and far less bruising involved in RFA treatment for varicose veins.

Can varicose veins come back after radiofrequency ablation?

Yes, varicose veins can come back after treatment. This may be because new veins become varicose over time, untreated tributary veins enlarge, or rarely because the treated vein reopens. Some patients need further treatment in the future.

What are the risks and possible complications of radiofrequency ablation for varicose veins?

As with any procedure, there are some risks and possible complications of RFA for varicose veins that it’s important to be aware of:

Common, mild side effects

• Mild pain, tightness, or tenderness along the treated vein
• Bruising or swelling at the insertion site
• A warm or pulling sensation in your leg
• Temporary numbness or tingling near the treatment area
• Skin irritation or localised redness

Less common but possible complications

• Inflammation along the treated vein
• Superficial thrombophlebitis or tender inflammatory lumps along the treated vein
• Skin burns
• Paraesthesia (numbness or nerve irritation)
• Infection at the catheter insertion site (rare)
• Deep vein thrombosis (DVT), which is uncommon but important to recognise
• Pulmonary embolism

What are the symptoms of nerve damage after radiofrequency ablation for varicose veins?

There is a small risk of nerve irritation after radiofrequency ablation for varicose veins, particularly when veins below the knee are treated. Symptoms are usually temporary but can occasionally persist. Signs include:

• Numbness in the treated area, occasionally radiating down the leg into the foot
• Pins and needles/tingling sensations in the affected area
• Burning or sharp pain that extends down your leg into your foot
• Sensitivity to touch in the affected area

How much does radiofrequency ablation for varicose veins cost at Nuffield Health?

Select your local Nuffield Health hospital to find contact details and guide prices for radiofrequency ablation for varicose veins. Please note that the guide price stated is an approximate cost of treatment only. You will be given a fixed all-inclusive price for treatment following your initial consultation with a consultant.