1How is the RFA Procedure done?
The procedure is performed on an outpatient basis. Using ultrasound, we will position the catheter into the diseased vein through a small opening in the skin. The tiny catheter powered by radio frequency energy delivers heat to the vein wall. As the thermal energy is delivered, the vein wall shrinks and the vein is sealed closed. Once the diseased vein is closed, blood is re-routed to other health veins.
2What happens after the Procedure?
Following the Procedure, a simple bandage is placed over the insertion point, and additional compression may be provided to aid your healing. We will encourage you to walk and to refrain from extended standing and strenuous actives for a short period of time. Most patients who undergo the closure procedure typically resume normal activities within 1 to 2 days.
3Is the Radio Frequency Ablation (RFA) Procedure painful?
Patients generally report feeling little, if any, pain during and after the procedure
4How quickly can I resume normal activity?
Patients are encouraged to walk immediately following the procedure, and most patients resume normal activities within 1 to 2 days.
5How soon after treatment will my symptoms improve?
Most patients report a noticeable improvement in their symptoms within 1 to 2 weeks following the procedure.
6Is there any scarring, bruising, or swelling after the procedure?
Most patients report minimal to no scarring, bruising, or swelling following the RFA procedure.
7How is the RFA Procedure different from endogenous laser?
In the only head-to-head trial of its kind, the catheter showed statistical superiority over 980nm endogenous laser. Patients treated with the catheter experienced less pain, less bruising, fewer complications and relaxed quality of life improvement up to four times faster than those treated with endogenous laser ablation.
8How is the RFA different from vein stripping?
During vein stripping, incisions are made in the groin and calf, and a stripper tool is threaded through the diseased vein, to pull the vein out of the leg. With the RFA procedure, only one small incision is made at the insertion site and the vein is then closed and left in place. This minimally invasive approach virtually eliminates pain and bruising associated with vein stripping surgery.
9Is the RFA Procedure covered by Medical Aid?
The RFA Procedure is covered by most Medical Aids for patients diagnosed with venous reflux.
10Are all varicose veins the same?
Varicose veins generally refer to veins on the legs. There are different types, mainly depending on size.
Spider or thread veins are known as telangiectasia’s or reticular veins being defined by size (<0.5mm and 0.5-3mm respectively), arise from the microcirculation and are predominantly a cosmetic problem.
Actual varicose veins are those protruding out, generally more than 3 mm, but more importantly, are branches from deeper veins and are not just a cosmetic problem but also a health concern.
Varicose veins may also occur in the pelvis causing “Pelvic Congestion Syndrome’ - a common condition in young women causing pelvis heaviness and pain. In this condition, the ovarian veins are actually varicose although they cannot be seen and there may or may not be concomitant groin or thigh veins present.
11What is the biggest misconception about varicose veins?
The biggest misconception is that varicose veins are a cosmetic issue only. Varicose veins can cause many symptoms that affect quality of life, and the same process that causes unsightly veins in some, causes swelling, skin pigmentation, skin damage and ulceration (wounds) in others. It is all part of the same process and can be severe. Once skin pigmentation and damage have occurred, it is largely irreversible.
The other misconception is that varicose veins should be not be treated. However, studies have shown that people with symptoms have decreased quality of life and treating venous disease properly is definitely worthwhile. Patients with vein problems are generally young and healthy and have long life expectancies. Thus treating them is certainly valuable.
Another lack of understanding in the medical field, is that most leg wounds are actually from an underlying vein problem, however, patients are often not fully assessed and treated and only managed with dressings. Treating a venous cause surgically, makes a big difference to the rate of wound healing and reduces the rate of recurrence of wounds. All patients with leg wounds should have their vascular system properly evaluated.
As venous disease is growing areas of intervention are becoming more and more recognized. A third of patients with pelvic congestion syndrome have a venous issue as the cause.
Patients who have suffered from deep vein thrombosis, also often get leg problems and more effective ways of investigating and treating them are becoming available.
12What are the main causes of varicose veins?
Varicose veins are genetic and run in families. There is a change in the ratio of collagen to muscle in a vein wall which weakens the wall and it dilates. Veins carry blood out of the leg and back to the heart against gravity. They therefore have valves within in them to prevent backflow of blood. When a vein dilates, these valves become incompetent and blood refluxes or ‘backflows’ into the leg.
Less commonly, deep vein thrombosis may damage valves rendering them incompetent.
Rarely veins are from congenital problems; where a patient is born without valves in the veins, or born with a vein malformation.
13To what extent does one’s lifestyle play a role in the occurrence of varicose veins?
Varicose veins and symptoms may be aggravated by being overweight, smoking and being sedentary.
14Can anyone get varicose veins? Or are certain people more prone to getting varicose veins?
Veins are predominantly genetic, however, hormones can definitely worsen and aggravate veins in some women - this can be seen in pregnancy, when on the pill or taking other hormonal treatment.
Standing occupations will definitely cause vein disease to progress more rapidly. Typical professions include teachers, chefs, hairdressers and nurses.
A patient who has had a deep vein thrombosis (DVT) may also develop problems with the more superificial veins.
15Is it something that one can prevent?
Varicose veins are not preventable or curable, however, they are maintainable. Veins can recur. We counsel patients extensively on venous disease. Thus, if a patient has a procedure and starts to get any new symptoms or new veins, they come in early and we can usually treat them by a simple method, rather than waiting for the process to get to an advanced stage needing repeat surgery.
Additionally, prior to any surgery proper vein mapping must be undertaken and all problem veins treated initially – this will reduce recurrence.
With the above methods, veins are manageable.
16Are varicose veins dangerous? If so, why? If not, why not?
The general answer is no. Veins affect quality of life more than pose a life-threatening condition. There have been studies done showing that patients with varicose veins do have a slightly increased risk of deep vein thrombosis, however, this is likely more related to having similar risk factors.
Sometimes varicose veins can cause more serious problems. The superficial veins can thrombose (clot) resulting in a tender, firm vein which is painful. If this is near a deep vein there is the risk of extension into the deep veins, and a deep vein thrombosis developing. This condition needs to be properly evaluated and treated.
Another more troublesome complication is bleeding - this may occur if a varicose vein is traumatized.
Wound formation is the most advanced form of venous disease and is really difficult to manage as these wounds can take long to heal. Preventing this is optimal, however if present, we have developed a team approach with surgical treatment, wound care and lymphatic management to expedite healing and reduce recurrence.
17Are varicose veins painful or uncomfortable?
They often are. Some people experience symptoms on the veins themselves when they dilate. The veins are surrounded by little nerves so when they are forced to carry extra blood they dilate and stretch these nerves and this is perceived as pain.
More commonly, the discomfort is more generalized in the leg from fluid retention, or from abnormal veins passing through muscle beds. Patients describe throbbing heaviness, burning, itching, tingling, muscle cramps and restless legs.
In some people, there are no symptoms at all.
18When should you consult a doctor regarding your varicose veins? Are there specific signs to look out for?
There are 3 reasons we treat varicose veins:
- To treat symptoms. Thus, anyone experiencing any leg symptoms from varicose as described above (heavy, throbbing legs etc) would benefit from treatment.
- To prevent progression of disease. In some people the only concern is unsightly veins, however, even in this group up to a third of patients will progress during their lifetime to more advanced disease - meaning swelling, skin pigmentation, skin damage and wound formation.
All patients with advanced disease should have treatment. Skin pigmentation and damage is already irreversible and one needs to prevent this getting worse.
- Cosmesis. In some patients, cosmesis is the only concern and it is important to treat this concern. Veins can have a very negative psychological impact on a patient resulting in them avoiding situations where they would need to expose their legs - such as going to the beach, or prevents them wearing certain clothing. Treating the veins can improve this negative pscyhological aspect and improve quality of life of many people. The impact of unsightly veins is often not recognized.
19What are the different options regarding treatment of varicose veins?
Traditional surgical treatment involved surgical stripping of the larger veins - a largely uncomfortable procedure This has been replaced by more minimally invasive techniques. We use catheters that use heat, chemical or glue to ‘seal’ off problem veins and redirect blood to veins that are currently working properly in the leg. Optimal treatment and results, do require proper vein mapping pre-operatively.
Other adjunctive treatments include injecting a foam chemical into veins (very helpful for small veins and wounds) and microphebectomies which refers to surgical removal of procuring veins through tiny incisions.
All these procedures can be done under local anesthetic, without the need for hospital admission, surgical incisions and sutures.
20When should you have the varicose veins removed? In what cases will it not be necessary?
Veins should be removed if they are causing symptoms, if there is advanced vein disease (swelling, skin pigmentation, skin damage, wound formation), if there is a health concern or for cosmesis.
If the veins do not bother a person and are causing no described signs or symptoms, the patient should be aware of changes that can occur - development of larger veins, development of symptoms and development of signs described - and get them treated at that point. Veins will never get better on their own and will always progress, however progression is generally slow and variable in individuals so it is safe to monitor if a person so prefers. Compression stockings would be advisable in this group to maintain the leg as it is and slow down progression.