RFA is a novel endovenous method of treating varicose veins without surgery. Instead of tying and removing the abnormal veins, they are heated by Radiofrequency energy. The heat kills the walls of the veins and the body then naturally absorbs the dead tissue and the abnormal veins are destroyed. It is performed in an operating theatre.

Almost all patients with varicose veins are suitable for RFA. Those few who are not suitable (usually those with small recurrent veins after previous surgery) can usually be managed with just foam Sclerotherapy (injections into veins).

Endovenous means inside the vein, so the next thing the doctor has to do is to get inside your vein. Some form of an anesthetic is given prior to surgery, either a general or a spinal anesthetic. Your anesthesia doctor will discuss this with you prior to the procedure and you can opt for one form or the other if you are deemed fit for both, as both are safe and standard. An ultrasound scan is then performed and the veins to be treated are marked with a pen. You lie on the operation table and your leg is cleaned and covered with drapes. Depending on which veins are to be treated, you may be on your back or your front. All these steps are guided by ultrasound scanning.

Then a needle is inserted into the target vein. A wire is passed through the needle and up the vein. The needle is removed and a catheter (thin plastic tubing) is passed over the wire, up the vein and the wire removed.

An RFA fibre is passed up the catheter so its tip lies at the highest point to be heated (usually your groin crease). A large quantity of local anesthetic solution is then injected around the vein through multiple tiny needle pricks. The Radiofrequency fibre is then fired up and pulled down the vein over about 5 minutes. You will hear a warning buzzer ringing but won’t feel any pain. If you’re having both legs treated the process is repeated on the other leg. The fibre and catheter are removed and the needle puncture covered with a small dressing.

The treatment takes about 20-30 minutes per leg. You may also have some foam Sclerotherapy or some avulsions undertaken and a compression stocking is then put on.

Soon after your treatment you will be either shifted to the ward or allowed home at the end of the day if you are a Day Care patient. It is advisable not to drive but to take public transport, walk or have a friend drive you. You will have to wear the stockings for up to two weeks and you will be given instructions about how to bathe. You should be able to go back to work in a day or two and get on with most normal activities.
You cannot swim or get your legs wet during the period in which you have been advised to wear the stockings. Most patients experience a tightening sensation along the length of the treated vein and some get pain in that area around 5 days later but this is usually mild. Normal anti-inflammatory drugs like Ibuprofen are normally sufficient to relieve it. We recommend a minimum of three 20 minute walks each day after the procedure.

We advise that you do not drive at least 48 hours after RFA. You should only drive again when you are free of pain and able to perform an emergency stop comfortably.

You can usually return to work after 36 hours depending on your recovery and the type of work that you do. If you develop phlebitis (lumpy inflammation along your vein), you may not feel like returning to work for about 10 days. Avoid strenuous exercise for 3 weeks and then gradually build up the amount you do.

Sitting down for long periods with your knees bent increases the risk of a DVT. You should avoid long haul travel (greater than 4 hrs) for at least four weeks after your procedure.

Ideally the first follow-up is after a week and then after 1 month. Upon discharge from hospital, the nurse will help you with the appointments.

The results of the procedure are generally very good. Studies have shown that the vein is sealed up in nearly everyone who has RFA (90-100 out of 100 people). Some studies have also shown that there is lesser degree of bruising and post procedure pain in RFA compared to surgical stripping and EVLT (traditional laser).

No. The important veins in your leg that return blood to your heart are the deep veins, which are not damaged by this treatment. The vein treated by RFA had reflux (blood going the wrong way). Some people’s circulation is better after treating the refluxing vein.

No. The black color around ankles is the iron deposited from your own blood and is like a tattoo. It might however become slightly lighter in a few months.

RFA follows the same principle as laser i.e. heat/thermal destruction of vein, but has been proven worldwide to be as effective as laser but with less pain and bruising than the traditional laser. Hence it is becoming the preferred modality of treatment of varicose veins worldwide.

If you are having treatment just to relieve symptoms then no further treatment is usually necessary. Most patients however wish also to improve the appearance of their veins and of these about 80% will require further treatment.

Additional treatment for the varicosities can be either by avulsions (mini incisions) or foam Sclerotherapy (injections). These additional treatments can be undertaken at the time of the RFA or more usually after a delay of 4-6 weeks. If you have extensive varicose veins on both legs it is very unlikely that you will be able to have all the additional treatment undertaken at the time of the RFA. Your doctor will advise you on this.
In avulsions, small incisions are made over the veins and they are teased out with a hook. You may require many small incisions but they heal easily without stitches and with minimal scarring. Foam Sclerotherapy, using injections like Polidochonol foam into the veins, is the commonest means of dealing with residual varicose veins after RFA and is highly effective for these.

Serious complications after RFA are very rare.

• Thrombophlebitis: RFA works by heating the wall of the vein and an inevitable and deliberate response to the heat is an inflammation of the vein wall. You may feel the vein that has been treated become hard and tender. Varicose veins that feed from the treated vein may also become hard and lumpy as some blood clot forms within them. This clot is not dangerous and your body will naturally absorb it over a few weeks.
• Nerve damage: As nerves can lie alongside the veins these may also become damaged by the heat or by avulsions and a few patients notice small patches of numbness on their skin. These usually resolve over a few months. The incidence of this happening is less than 2 %.
• Burns: Although it is possible to burn the skin with the laser in practice this is very rare indeed.
• DVT: A DVT is a blood clot in the deep veins in the leg. It is a recognized complication of surgery and can be dangerous if the clot breaks away and travels to the lungs. The risk of getting a DVT after RFA is very low but has been reported.

Many patients considering RFA are confused as to which treatment to go for. This is unsurprising, as there are several options including doing nothing, having an operation and several new non-surgical treatments like Foam Sclerotherapy, EVLT etc.

Much will depend on the experience of your vascular specialist. Some surgeons still only undertake surgery but most now offer at least one of the new treatment options. Doing nothing is a good option if you are not bothered by the appearance of your veins and they are not causing significant symptoms.