Patient Information on VNUS closure (Radiofrequency ablation of varicose veins)

Who is this leaflet for and what is its aim?

This leaflet is for patients who have been diagnosed with varicose veins and have been recommended to have Radiofrequency ablation of varicose veins.

This leaflet aims to explain the procedure and its risks.

Background Information

Radiofrequency ablation (RFA) is a minimally invasive treatment for varicose veins and is approved and recommended as a first line treatment for varicose veins by the National Institute for Clinical Excellence (NICE, www.nice.org.uk), which assesses the safety and effectiveness of NHS treatments.

Further information is available in the NICE Clinical Guidelines CG168 (2013).

The size and shape of the varicose veins will determine whether we are able to treat you using RFA. The RFA catheter is attached to a generator which is used to ablate (close) the faulty vein using locally directed heat, redirecting blood through nearby healthy veins as a result. You will be able to walk immediately after the treatment and to go home on the day of treatment.

The procedure is often performed under local anaesthetic. This local anaesthetic is injected along the whole course of the vein to numb the area and act as a heat sink. It is called tumescent anaesthetic.

Occasionally for extensive veins or treatment for both legs a general anaesthetic may be required. The same tumescent anaesthetic is used during a general anaesthetic.

The procedure

All patients who are suitable for RFA will have been assessed by a consultant in the vascular clinic and will undergo a detailed duplex ultrasound scan of their veins to confirm suitability for the treatment. You will not need to attend the hospital again until the day of your procedure.

We will ask if you take any tablets or use any other types of medication either prescribed by a doctor or bought over the counter in a pharmacy. Please bring all your medications and any packaging (if available) with you.

This procedure involves the use of anaesthesia. We explain about the different types of anaesthesia or sedation we may use at the end of this leaflet.

Most people who have this type of procedure will not need to stay in hospital overnight.

Please do not use skin moisturiser on the day of your procedure. For most operations, you do not need to have the hair around the site of the operation removed. However, sometimes the healthcare team need to see or reach your skin and if this is necessary they will use an electric hair clipper with a single-use disposable head, on the day of the surgery.

Please do not shave the hair yourself or use a razor to remove hair, as this can increase the risk of infection. Your healthcare team will be happy to discuss this with you.

An ultrasound scan will be used to mark the veins that require treatment. An injection will numb the skin and a small flexible wire will be passed into the vein. A fine tube is passed over this wire and then the RFA treatment catheter is threaded through the tube. The position of the treatment catheter will be checked and further local anaesthetic will be injected around the vein again guided by ultrasound – this is called tumescent anaesthetic.

The generator then creates heat energy to seal the vein up from the inside. This takes just a few minutes. You should not feel anything during the treatment. Once the vein has been sealed, the treatment catheter is removed.

Occasionally varicose veins that have been marked by the surgeon prior to the procedure may be removed through small incisions (phlebectomies), or treatment using injection of foam sclerotherapy (ultrasound guided foam sclerotherapy).

The small incisions needed for treatment are closed with skin glue. This will flake off on its own after a few days and should be left alone.

We may give you an injection to reduce the risk of deep vein thrombosis after the treatment, or prescribe you some tablets to take.

Finally, a bandage is applied to the leg. This bandage should be kept on for one day.

An elastic compression stocking may then be worn for a further week if advised by the treating team.

After the procedure

After RFA you will be able to walk immediately and then go home. You should not drive home. If you are travelling for more than an hour from the hospital you should sit on the back seat with your leg(s) up. Stop every hour and walk around for five minutes.

Resuming normal activities including work

Normal activity, including work, can be resumed as soon as you like, and you should aim to walk around for at least 30 minutes every day.

Contact sports, heavy exercise and swimming should be avoided for one to two weeks.

Avoid getting any wounds wet for 48 hours and avoid immersion bathing for 1 week to reduce the risk of infection.

Special measures after the procedure

When the bandage is taken off, you may see some bruising or hardness under the skin. This is quite normal and will gradually settle.

It is relatively common for the treated area to feel like a cord, which may have some mild redness which should recede rapidly.

If given a stocking, you should wear the stocking during the day and night for up to one week, but may remove it for showering.

You will not routinely be given a supply of painkillers to take home, as most patients do not require anything stronger than paracetamol.

You should expect some soreness along the treated segment, and this can be at its worst 5-10 days after treatment. Paracetamol and ibuprofen should be more than sufficient.

Intended benefits

RFA intends to treat your varicose veins, improve your symptoms and reduce complications of varicose vein disease.

RFA can be performed under a local anaesthetic. Normal activity can be resumed straight away, and you should be able to return to work within 1-2 days.

RFA removes the need for a groin incision in the skin, leaves fewer scars and less potential for complications such as wound infection and pain following surgery.

RFA closure has been shown to cause less pain and bruising than conventional surgery or endovenous laser therapy.

Risks

There is a small chance the vein may not be completely obliterated by the RFA catheter (This occurs in about 3% of patients).

There is a 10% chance of recurrence of your varicose veins at 5 years, but this may not cause a problem.

There is a chance that not all of the veins in the treated leg will disappear but this can happen with all vein treatments and further treatment can sometimes be contemplated.

Some patients have bruising or tenderness that lasts for longer than a few days. This bruising is more common if you have had varicose veins removed (phlebectomies) at the same time as the RFA procedure.

It is not uncommon for some discomfort to develop around the ablated vein and for it to feel like a “cord” under your skin between 5 and 10 days after the procedure due to inflammation. If this occurs you may require some anti-inflammatory tablets such as ibuprofen.

About 1-5% of patients experience some numbness in the leg after RFA but this is almost always temporary.

There is a very small risk of skin burns from the RFA catheter.

Skin pigmentation along the line of the treated vein can occur – like a brown line. This normally fades but can be permanent.

Deep vein thrombosis (DVT) – the formation of a blood clot in the deep veins of the leg - is the main concern after any vein treatment, however the risk is small – approximately 1:300-1:1000. It is lower than after conventional varicose vein surgery.

Alternatives

Varicose veins are an extremely common condition. There are a number of alternative treatments available for varicose veins listed below. One of these may be more appropriate for your varicose veins but your surgeon will discuss this with you.

Ultrasound guided foam sclerotherapy

This is also a minimally invasive procedure but it is not as technically effective as RFA. However it can be used in more tortuous (wiggly) veins.

Conventional varicose vein surgery

This usually requires a general anaesthetic, causes more bruising and discomfort and requires larger surgical incisions than RFA.

Compression stockings and skin care

This will not resolve the varicose veins but may control the symptoms.

Information and support

We may give you additional patient information before or after the procedure, for example, leaflets that explain what to do after the procedure and what problems to look out for. If you have any questions or anxieties, please feel free to ask a member of staff, email our vascular specialist nurses or call 01223 348526.

Further information is available from the Vascular Society website (opens in a new tab).

Medication

Please bring with you all of your medications and its packaging (including inhalers, injections, creams, eye drops, patches, insulin and herbal remedies), a current repeat prescription from your GP, any cards about your treatment and any information that you have been given relevant to your care in hospital, such as x-rays or test results.

Please tell the ward staff about all of the medicines you use. Take your medications as normal on the day of the procedure unless you have been specifically told not to take a drug or drugs before or on the day by a member of your medical team. Do not take any medications used to treat diabetes.

Pharmacists visit the wards regularly and can help with any medicine queries.

MyChart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device

More information is available on our website: MyChart