36479 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, laser; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition to code fo

Name of the Procedure:

Endovenous Ablation Therapy of Incompetent Vein, Extremity, Percutaneous, Laser (Subsequent Vein(s) Treated in a Single Extremity)

Summary

Endovenous ablation therapy is a minimally invasive procedure used to treat varicose veins and venous insufficiency. This specific procedure involves using a laser to close off and seal incompetent veins in the legs, with each subsequent vein treated through separate access sites in the same extremity.

Purpose

Endovenous ablation aims to:

• Alleviate symptoms caused by varicose veins, such as pain, swelling, and skin changes.
• Improve blood flow and circulation in the affected limb.
• Reduce the likelihood of complications related to chronic venous insufficiency, such as leg ulcers.

Indications

This procedure is indicated for patients experiencing:

• Symptomatic varicose veins (pain, heaviness, swelling)
• Venous insufficiency with visible dysfunctional veins
• Skin changes or ulcerations due to poor blood flow

It is appropriate for patients who:

• Have tried conservative treatments (e.g., compression stockings) without success
• Are in generally good health and can undergo a percutaneous procedure

Preparation

Patients may be instructed to:

• Avoid eating or drinking for a few hours before the procedure.
• Adjust certain medications as advised by their physician.
• Undergo an ultrasound or other imaging studies to map the veins.

Procedure Description

1. The patient is positioned, and the targeted veins are identified using ultrasound imaging.
2. A local anesthetic is applied to the treatment area.
3. A small incision is made to insert a catheter into the vein.
4. The catheter guides a laser fiber into the vein.
5. The laser energy is delivered, causing the vein to heat, collapse, and seal shut.
6. Each subsequent vein is treated through separate access sites with similar steps.
7. The catheter and laser fiber are removed, and the incision site is bandaged.

Duration

The procedure typically takes about 30 to 60 minutes per vein treated.

Setting

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

Personnel

• Interventional radiologist or vascular surgeon
• Registered nurse
• Ultrasound technologist

Risks and Complications

Common risks include:

• Mild bruising or swelling at the incision site
• Temporary numbness or tingling

Rare complications may include:

• Infection at the incision site
• Deep vein thrombosis
• Skin burns

Benefits

• Relief from symptoms such as pain and swelling.
• Improved aesthetic appearance of the affected limb.
• Enhanced quality of life due to better mobility and comfort.
• Benefits are often realized within a few days to weeks after the procedure.

Recovery

Post-procedure care includes:

• Wearing compression stockings for a prescribed period.
• Walking regularly to promote circulation.
• Avoiding strenuous activities for a few days.
• Follow-up ultrasound check-ups to ensure the vein is properly sealed.

Most patients return to their normal activities within a few days.

Alternatives

Other treatment options include:

• Sclerotherapy (injecting a solution into the vein)
• Surgical vein stripping
• Conservative management with compression stockings

Each alternative has its own pros and cons regarding invasiveness, recovery time, and effectiveness.

Patient Experience

During the procedure, patients may feel slight pressure or mild discomfort. Post-procedure, they might experience some bruising and soreness at the treatment sites, which can be managed with over-the-counter pain medication and wearing compression stockings. Most patients find significant symptom relief soon after the procedure.