36475 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; first vein treated

Name of the Procedure:

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

Summary

Endovenous ablation therapy is a minimally invasive procedure used to treat varicose veins. It involves using radiofrequency energy to heat and seal off an incompetent vein, which is a vein with malfunctioning valves that cause blood to pool and create swelling and discomfort in the leg.

Purpose

The procedure treats venous insufficiency, commonly associated with varicose veins. By sealing off the problematic vein, it helps reduce pain, swelling, and the appearance of varicose veins. It also prevents complications like skin ulcers and blood clots.

Indications

• Visible varicose veins
• Leg pain or heaviness
• Swelling in the leg
• Skin changes or ulcers
• Recurrent episodes of phlebitis (vein inflammation)
• Bleeding from veins

Preparation

• Avoid blood-thinning medications as advised by the doctor.
• Fasting may be required a few hours before the procedure.
• Wear loose, comfortable clothing on the day of the procedure.
• A pre-procedure ultrasound may be performed to map the veins.

Procedure Description

1. The patient lies on an examination table, and the targeted leg is cleaned and sterilized.
2. Local anesthesia is administered to numb the treatment area.
3. A thin catheter is inserted through a small incision in the skin and guided into the incompetent vein using ultrasound.
4. Radiofrequency energy is delivered through the catheter to heat the vein wall, causing it to collapse and seal shut.
5. The catheter is gradually withdrawn, and the vein is monitored via ultrasound to ensure successful ablation.
6. The incision site is dressed, and compression stockings are applied to the leg.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

Endovenous ablation is usually performed in an outpatient clinic or an ambulatory surgical center.

Personnel

• Interventional Radiologist or Vascular Surgeon
• Registered Nurse (RN)
• Ultrasound Technician
• Anesthesiologist, if sedation is used

Risks and Complications

• Bruising and swelling at the treatment site
• Infection
• Nerve injury
• Blood clot formation
• Skin burns or discoloration
• Recurrence of varicose veins

Benefits

• Relief from pain and swelling
• Improved leg appearance
• Minimal scarring
• Short recovery time
• Reduced risk of complications from untreated varicose veins

Recovery

• Wear compression stockings for at least one week post-procedure.
• Walk regularly to promote circulation.
• Avoid heavy lifting and vigorous activities for a few days.
• A follow-up ultrasound may be scheduled to ensure the vein remains sealed.

Alternatives

• Sclerotherapy: Injection of a solution to close veins.
• Laser ablation: Uses laser energy instead of radiofrequency.
• Surgical vein stripping: Removing problem veins through incisions.

• Conservative treatments: Compression stockings and lifestyle changes.

  Pros of Endovenous Ablation:

• Minimally invasive
• Short recovery time
• High success rate

Cons of Alternatives:

• Higher invasiveness (surgical stripping)
• Potential for less effectiveness (conservative treatments)
• Multiple sessions (sclerotherapy)

Patient Experience

Patients typically feel mild discomfort during the injection of local anesthesia. Most report a sensation of warmth or tingling as the radiofrequency energy is applied but not pain. After the procedure, mild bruising and soreness are common, but these usually resolve within a couple of weeks. Pain management includes over-the-counter pain relievers and wearing compression stockings for enhanced comfort and recovery.