36476 Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, radiofrequency; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition t

Name of the Procedure:

Endovenous Ablation Therapy of Incompetent Vein, Extremity, Percutaneous, Radiofrequency (Subsequent Vein)

Summary

Endovenous ablation therapy using radiofrequency is a minimally invasive procedure designed to treat varicose veins or other venous insufficiencies in the lower extremities. This therapy involves using radiofrequency energy to heat and close off faulty veins, redirecting blood flow to healthier veins. The description focuses on treating subsequent veins in a single extremity through separate entry points.

Purpose

Endovenous ablation therapy addresses venous insufficiency, primarily varicose veins, which occur when veins in the legs fail to circulate blood efficiently. The goal is to reduce pain, swelling, and the appearance of varicose veins while improving overall blood flow in the legs.

Indications

• Visible varicose veins
• Leg pain, aching, or cramping
• Swelling in the lower extremities
• Skin changes or ulcers associated with chronic venous insufficiency
• Failed conservative treatments like compression stockings or lifestyle changes

Preparation

• Follow fasting instructions, typically not eating or drinking for several hours before the procedure.
• Adjust medications as directed by your doctor, including possibly stopping blood thinners.
• Undergo an ultrasound of the leg veins to identify the affected veins and assess for blood clots.

Procedure Description

1. The patient is positioned on the treatment table, and the target area is cleaned and sterilized.
2. Local anesthesia is administered to numb the treatment area.
3. Using ultrasound guidance, a catheter is inserted into the affected vein through a small incision in the skin.
4. The catheter delivers radiofrequency energy along the length of the vein, causing its walls to heat up, collapse, and seal shut.
5. The catheter is slowly withdrawn, and additional veins may be treated through separate access points if necessary.
6. Once treated, the incisions are small and usually closed with a bandage or small adhesive strips.

Duration

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

Setting

Endovenous ablation therapy is usually performed in an outpatient clinic, hospital, or surgical center.

Personnel

• Vascular surgeon or interventional radiologist
• Registered nurse
• Ultrasound technician
• Anesthesiologist or nurse anesthetist (if sedation is used)

Risks and Complications

• Bruising and swelling at the treatment site
• Skin burns or discoloration
• Infection at the incision site
• Nerve damage leading to numbness
• Deep vein thrombosis or blood clots

Benefits

• Reduced pain and discomfort from varicose veins
• Improved appearance of the leg
• Better overall blood circulation
• Minimal downtime and quick recovery

Recovery

• Wear compression stockings for 1-2 weeks post-procedure to aid healing.
• Avoid strenuous activity and heavy lifting for a few days.
• Walk regularly as recommended to encourage blood flow.
• Follow-up appointment may be scheduled to monitor the treatment's success.

Alternatives

• Sclerotherapy: Injection of a solution to collapse veins; suitable for smaller veins.
• Laser Ablation: Similar to radiofrequency ablation but uses laser energy.
• Vein stripping: Surgical removal of large varicose veins; more invasive.
• Conservative treatments: Use of compression stockings and lifestyle changes.

Patient Experience

During the procedure, patients may feel a slight pressure or warmth but should not experience pain due to local anesthesia. Post-procedure, mild discomfort, bruising, or swelling is common and can be managed with over-the-counter pain relievers. Most patients can return to normal activities within a few days and experience significant symptom relief within a few weeks.