Endovenous Ablations are now well developed and replace the hight ligation and stripping in 80% of cases in the USA where they have seen the day.
These techniques are practiced under ultrasound guidance and local anesthesia, as an outpatient, and allow the resumption of normal activities the next day.
They have the considerable advantages of not requiring general anesthesia, no hospitatlisation not stop work or activity, no dressing, no pain or scarring.
In France, reimbursement by social security has been accepted since December 2015.
The implementation of the various techiques is identical, only the heat source is different.
The radio frequency is an endo venous and mini invasive ambulatory ablation done in a private clinic under local anaesthesia which allows the patient to continue his activities or work.
The heating of the internal walls of the varicoses veins with radio frequency according to the closurefast system is carried out by simple catheterisation and induces the retraction and the sclerosis of veins.
Radio frequency is an ambulatory treatment done a in private clinic i.e. the check in and the check out are done the very same day because of lightness of the intervention and done under loco-regional anaesthesia.
As for phlebectomy, driving of a car, work and the usual activities are generally possible on the following day.
The equipment consists of a RF generator which calculates precisely all parameters of the process: time, temperature ..., which standardizes the technique.
These are the same procedures regardless of the patients and the operators.
The heating probe is connected to the generator, it is introduced by simple catheterization until the origin of the varicose vein and then gradually removed in 7 cm increments as the varicose vein is treated.
Once the probe is inserted the vein is isolated by injecting water under ultrasound around it.
It is not as likely to accidentally burn anything other than the varicose vein we are treating.
The procedure is performed without general anesthesia, it can stop at any pain felt by the patient.
The technique is intended for the treatment of the larger saphene veins when it is varicosed, in its part nearest to the root of the thigh.
The varicose vein must be of a gauge higher than 4 mm, located at an depth higher than 1 cm, rectilinear and never treated before.
When these conditions and the procedure are respected little or no pain is observed, more so cutaneous incidents and nervous lesions are rare.
According to the most recent studies (see appendix) radio frequency which accounts for 40% of the acts practiced in the United Kingdom, 80% in the USA for 350,000 interventions in the world in the described method, is the most effective technique in terms of longevity in time and with the simplest follow up.
The implementation is the same and the results comparable, the only source of heat is different.
The phlebectomy of a varicose vein is the ablation of branches or segments of the saphenous veins through micro-punctures made with the bevel of a simple IV needle (INTER-F)
In most cases, they will not require any stitching or any particular post-operative care.
It is practiced on varicose veins too superficial to be sclerosed or “heated” because of a risk of pigmentation or skin burn.
The procedure can take up to 60 minutes approximatively because of the precise and meticulous gestures required.
Phlebectomy is an ambulatory operation done in a private clinic as an out-patient, on the same day the medical act is done under loco-regional anesthesia.
As for the radio frequency, the driving of a car, work and usual activities are generally possible on of the following day. In the treatment of larger varicose veins, phlebectomy is required for a full and esthetic result.
Before surgery a rigorous and precise mapping must be done to identify varices that will be extracted.
For marking the transillumination technique is essential.
More information about transillumination on the page SCLEROTHERAPY AND LASER on the "TRANSILLUMINATION" tab.
The institute of the leg has developed a tool to help in marking: The Venolux
One can leave the clinic 4 hours after the medical intervention, with very little or not pain.
Following the intervention, a compression bandage will be applied and be kept on for a more or less long time, decision of the doctor.
Very colored bruising along the treated area is usual, it takes up to 3 or 4 weeks to disappear and should not be exposed to any ultraviolet rays (sun lamps and UV rays).
If an inflammatory reaction is more important then can be tolerated an elastic contention can be useful during a few additional days. Taking up to 3 to 4 weeks to disappear hard and sensitive bulges will make their appearance.
A brown coloring of the skin can persist for a few weeks on the treated area, it will then disappears spontaneously.
They are rare even exceptional:
Phlebectomy is the treatment of larger varicose veins, an essential ambulatory, light and esthetic medical act without any counter indication to complement other treatments.