36473 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated

Name of the Procedure:

Endovenous Ablation Therapy of Incompetent Vein, Extremity, Inclusive of All Imaging Guidance and Monitoring, Percutaneous, Mechanochemical; First Vein Treated

Common Name(s):

Endovenous ablation, Mechanochemical ablation, Vein ablation therapy

Summary:

Endovenous ablation therapy is a minimally invasive procedure used to treat varicose veins and other vein-related issues in the extremities. The procedure involves using imaging guidance to insert a catheter into the targeted vein, where it then uses a combination of mechanical and chemical methods to close off the vein. This reduces symptoms and prevents further vein insufficiency.

Purpose:

Medical Condition or Problem Addressed:

Varicose veins, chronic venous insufficiency, leg swelling, and pain due to poorly functioning veins.

Goals or Expected Outcomes:

The goal is to close off the incompetent vein to improve blood flow, alleviate symptoms, and prevent further venous issues.

Indications:

Specific Symptoms or Conditions:

• Painful, swollen, or unsightly varicose veins
• Chronic leg swelling and pain
• Venous ulcers
• Skin changes/discoloration due to poor vein function

Patient Criteria:

• Confirmed diagnosis of vein incompetence through an ultrasound scan
• Suitable anatomy for a catheter-based approach
• No major contraindications such as a history of deep vein thrombosis (DVT) or certain clotting disorders

Preparation:

Pre-procedure Instructions:

• Patients may be advised to fast for a few hours before the procedure.
• They should inform the doctor of any medications they are taking, as some may need to be adjusted.
• A pre-procedure ultrasound is usually performed to map out the veins.

Diagnostic Tests or Assessments:

• Duplex ultrasound to evaluate the condition of the veins.

Procedure Description:

1. The patient lies down, and the area of the affected vein is cleaned and sterilized.
2. Local anesthesia is applied to numb the treatment area.
3. Using ultrasound guidance, a thin catheter is inserted into the incompetent vein through a small skin incision.
4. The catheter delivers a chemical sclerosant while simultaneously rotating a small wire inside to cause mechanical irritation.
5. This combination damages the vein walls, causing them to collapse and seal shut.
6. The catheter is removed, and the skin incision is closed with a small bandage.

Tools, Equipment, Technology:

• Ultrasound machine for imaging guidance
• Catheter with mechanochemical mechanisms
• Sterile bandages and local anesthetic

Anesthesia or Sedation:

Local anesthesia

Duration:

The procedure typically takes about 30 to 60 minutes, depending on the vein's size and location.

Setting:

The procedure is performed in an outpatient clinic or a specialized vein treatment center.

Personnel:

• Interventional radiologist or vascular surgeon
• Trained nurse or medical assistant
• Ultrasound technician

Risks and Complications:

Common Risks:

• Bruising at the insertion site
• Minor bleeding
• Temporary nerve injury

Rare Complications:

• Deep vein thrombosis (DVT)
• Infection
• Allergic reaction to the sclerosant

Management:

Most complications are manageable with routine follow-up care and proper adherence to post-procedure instructions.

Benefits:

Expected Benefits:

• Reduction in pain and swelling
• Improved appearance of the treated area
• Enhanced quality of life by preventing future vein complications

Realization Time:

Improvement typically noticed within a few weeks after the procedure.

Recovery:

Post-procedure Care:

• Patients can usually walk immediately after the procedure.
• They may need to wear compression stockings for a week or more to support healing.
• Avoid strenuous activities for a few days.

Expected Recovery Time:

Most people return to normal activities within 24-48 hours, with full recovery in one to two weeks.

Restrictions and Follow-up:

• Avoid heavy lifting or vigorous exercise for a few days.
• Follow-up ultrasound to ensure the treated vein remains closed.

Alternatives:

Other Treatment Options:

• Sclerotherapy
• Laser vein treatment
• Vein stripping surgery
• Radiofrequency ablation

Pros and Cons of Alternatives:

• Sclerotherapy: Less invasive but may require multiple sessions.
• Laser/RF Ablation: Effective but might involve more discomfort.
• Vein Stripping: More invasive with longer recovery time but may be necessary for severe cases.

Patient Experience:

During the Procedure:

• Minimal discomfort due to local anesthesia.
• May feel mild pressure or pulling sensation during catheter insertion.

After the Procedure:

• Mild bruising and soreness at the insertion site.
• Pain management with over-the-counter pain relievers.
• Compression stockings provide comfort and aid in recovery.