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Venous Ablation

Venous ablation is an exciting new technique that is revolutionizing the treatment of venous reflux in legs. This site gives a brief discussion of venous reflux and the venous ablation procedure.

Fig 1. In the normal situation, valves in the vein wall keep blood flowing toward the heart (green arrows). When the valves are damaged, blood can flow backwards (red arrows) dilating the vein and pooling in the leg. When the vein is ablated, normal blood flow direction is restored.

What is venous reflux?
Venous stasis is a common condition in which the flow of blood from the legs to the heart is abnormal. Most people assume that the heart pumps blood out to the legs and then pumps it back. That's only half right. Actually, the heart only pumps the blood out. Leg muscles pump it back. Every time a leg muscle tightens (called contraction), it squeezes the leg veins flat. Blood is pushed through the veins like toothpaste being squeezed from a tube. When everything is working normally, a series of one-way gates (called valves) makes sure that the blood can only move one direction: toward the heart. However, when the valves are damaged, the "muscle pump" doesn't work (imagine a busy intersection with no traffic signals). This condition is called reflux and most often involves a large leg vein called the saphenous vein. When saphenous reflux is present, blood simply pools in the legs, causing everything from unsightly varicose veins to severe pain and ulceration of the skin. [Fig. 1]

How is it treated?
The easiest treatment is to wear compression stockings. These special socks gently squeeze the leg, helping the muscle pump to work more effectively. If compression stockings do not help, the abnormal vein must be eliminated. Historically, this has been done with a surgical procedure called "vein stripping." It can now be done with a non-surgical technique known as venous ablation.

Fig 2. The laser fiber is inserted into the dilated vein. It is then activated and withdrawn, causing the vein to close down and become sealed off.

What is venous ablation?
Venous ablation eliminates the abnormal, refluxing vein by sealing it closed. The vein does not actually have to be removed from your body, as in vein stripping.

How is venous ablation done?
Through a tiny incision at the knee (the size of a pencil point), a small tube is placed into the saphenous vein. Then, a laser or radiofrequency fiber is passed through the tube into the vein. Once in place, the fiber is activated, delivering very localized heat to the vein wall. In response, the vein closes down and becomes permanently blocked. [Fig. 2]

Don't I need my veins?
Yes, veins are necessary for blood return from the legs to the heart. Venous ablation treats only the abnormal vein that is allowing blood to flow backwards. Since this vein has lost its ability to carry blood in the correct direction, it is no longer needed.

Is it painful?
The amount of energy delivered to the vein is actually very small and only affects the local vein wall. We use local anesthesia (like your dentist), but nothing stronger is generally needed. Afterwards, there may be some mild to moderate discomfort for a week to ten days, but this usually responds well to over-the-counter medications like aspirin or ibuprofen.

How quickly does it work?
The ablation procedure closes the vein immediately. The improvement in blood flow happens right away. However, it may take a few weeks for the original symptoms to go away, and large varicose veins may need some additional minor treatment.

Before and after images of a recent patient showing the marked improvement in their varicose veins, which are common viable signs of venous reflux.

Will it work for me?
If your saphenous vein has reflux, venous ablation will probably help to eliminate your symptoms. The best way to test for reflux is by ultrasound examination. OHSU offers a comprehensive ultrasound screening for saphenous reflux every Wednesdays. Appointments can be made by calling the Dotter Institute at (503) 494-7660. [See figures of sample cases]

Before and after images of a recent patient.