Radiofrequency Ablation (RFA) FAQs

Is Radiofrequency Ablation better than Sclerotherapy and Surgery?

Yes. Generally the vein disappears entirely and is less likely to reform. It is a less painful procedure with less tendency to staining.

Can all large veins be treated with RFA?

Treatment with RFA is usually confined to the main trunk saphenous veins, between the knee and the groin and the calf up to the region behind the knee. The affected veins usually are at least 5mm in diameter, straight, and deeply placed. Sometimes, only a short segment of the affected vein can be treated in this way, because the rest of the vein is too close to the skin to be treated safely with a laser.

Once the larger varicose vein trunks are treated with laser, the remaining varicose veins can be closed with ultrasound-guided sclerotherapy. This works out very well in practice because the pressure on these smaller remaining veins is usually less because of the preceding laser treatment. This allows the smaller veins to be well treated with UGS. Both treatments can be performed in one session, although it is not uncommon to require a few more injections a week later at follow-up in order to complete the first treatment.

Is RFA a safe treatment? What can go wrong?

There are generally very few side effects from radiofrequency; certainly less than following surgery or UGS. Because the catheter generates heat in the vein, excessive exposure to heat near the skin could cause a burn. In practice, this is a rare complication (we have not encountered a single incident in over 2500 patients). This is because of careful technique and the use of tumescent anaesthetic liquid placed around the outside of the vein which acts to confine the laser heat to the vein only.

Skin staining can occur, but usually involves large veins close to the skin’s surface, treated with UGS. Staining is not permanent, resolving in less than 24 months in most cases.

Bruising may occur, mainly in the thigh, but usually resolves over the course of a week with anti-inflammatory cream or tablets.

How long does the treatment take?

The treatment for one leg usually takes about an hour; about one and a half hours if we treat both legs at the same time.

Is the treatment painful?

The treatment is not painless but is generally very well tolerated. A local anaesthetic is injected around the vein to be treated with a very fine needle. This not only provides a painless environment for the laser treatment itself, but the sleeve of local anaesthetic fluid around each vein acts as a heat sink to protect the surrounding tissues from damage from the heat of the laser.

What happens after the treatment?

As for UGS, you will be fitted with a measured compression surgical stocking, and asked to go for a walk before returning home or indeed, back to work, should you so wish. An appointment will be made for you to return after one week for further assessment.

Your stocking should be worn, uninterrupted ideally, for one week, and during the daytime for the second week. We advise against strenuous exercise and hot pools during the first two weeks, preferring instead that you undertake daily walking from half an hour to an hour per day if possible.