Thermal Ablation Treatment for Varicose Veins

Thermal ablation for varicose veins is a procedure to close enlarged superficial veins by heating them from the inside. It is popularly known as “burning the vein from the inside”; however, surrounding tissues are preserved because controlled and safe heat is delivered using modern devices. This method is divided into two main categories: Radiofrequency (RF) ablation and Endovenous Laser Ablation (EVLA). Both are surgical-free, needle-puncture procedures performed under ultrasound guidance, and most people walk home on the same day.

What is the basic principle of thermal ablation?

The essence of the procedure is to insert a thin catheter into the problematic vein and close the inner surface of the vein with controlled heat. Once the vein is removed from “traffic,” blood is redirected to healthier veins. RF and laser aim for the same goal; the difference is the way heat is generated. RF produces heat with electrical energy, while laser produces heat with light at a specific wavelength.

How is the preparation before the procedure?

Fasting is generally not required; your medications and any history of clots are always queried. The vein to be treated, the entry point, and the closure boundary are planned with millimetric precision using Doppler ultrasound. An appropriate knee-high or thigh-high compression stocking is prepared for after the procedure.

How is the procedure performed?

The skin is numbed with local anesthesia. The vein is entered with a needle, and the RF or laser catheter is advanced over a thin wire and sheath. A special solution called tumescent anesthesia is delivered around the vein; this solution both provides pain relief and separates the vein from surrounding tissues to safely contain the heat inside. Then, as the catheter is slowly withdrawn, the vein is closed from the inside. The procedure time is 30–60 minutes in most cases. A small bandage and a compression stocking are applied afterward.

What is Radiofrequency (RF) ablation?

In RF ablation, the catheter tip heats the inside of the vein in a controlled manner, not exceeding approximately 120 °C. Modern RF catheters close the vein segment by segment; the energy and duration are optimized by the device at each step. This controlled heating ensures homogeneous closure, especially in large-diameter veins. Many centers report less “sensation of heat” during the procedure with RF. RF is very common for main trunks like the saphenous vein; if necessary, foam sclerotherapy can also be performed on additional side branches in the same session.

What is Endovenous Laser (EVLA) ablation?

In laser ablation, the fiber tip placed into the vein emits light at a specific wavelength; the light turns into heat and closes the vein. Current lasers use water-sensitive wavelengths like 1470 nm and radial (360°) fiber tips; this ensures even heat distribution, reducing pain and bruising. It is very effective in thin-to-medium-sized veins. In experienced hands, the success of EVLA is similar to RF. Lazer can also be combined with sclerotherapy for side branches if necessary.

RF or laser?

Both methods are first-line endovenous treatments according to guidelines and have high success rates. The main factors determining the choice are:

• The diameter and course of the vein,
• Proximity to the skin surface,
• Previous interventions,
• Co-existing spider/side branch varicose veins.

While RF provides a more “homogeneous” closure sensation in some large veins, modern laser fibers are highly successful in reducing spider veins, pain, and bruising. Consequently, both methods offer a strong alternative to surgery with the right patient and an experienced team.

What are the advantages of thermal ablation?

There are no incisions or stitches; the entry site is as small as a needle prick. General anesthesia is often not required; the procedure is comfortable with local anesthesia and tumescent solution. You walk on the same day and return to work and daily life shortly after. The cosmetic scar is minimal. If necessary, additional sessions can be planned for the other leg or remaining side branches. Significant relief from pain, swelling, and night cramps is expected in the long term; however, everyone’s healing rate is different.

Are there risks?

As with any procedure, there are minor risks here as well. Bruising, firmness, mild pain, and a “string-like” tight vein sensation at the entry site reduce within a few weeks. Rarely, superficial vein inflammation (trombophlebitis), temporary skin discoloration, or heat-related sensitivity may occur. The risk of deep vein thrombosis (DVT) is low, but close follow-up is maintained, especially in risk groups. Emergency consultation is necessary if sudden swelling, severe pain, or shortness of breath occurs after the procedure.

What is the post-procedure care?

Most centers recommend wearing compression stockings during the day for the first 1–2 weeks. Walking immediately is encouraged, but standing still for long periods and high heat (sauna-hot bath) are restricted in the first few days. Simple painkillers are sufficient for pain. You are called for a check-up within 1–2 weeks. Doppler ultrasound checks the vein closure and the adaptation of blood flow to the new pattern. Foam sclerotherapy is planned for remaining side branches if necessary.

How is the use of RF and laser combined with other methods?

Closing the main vein with RF or laser and performing foam sclerotherapy on significant superficial side branches in the same session provides rapid recovery in some patients. In very advanced cases, thermal methods can be combined with non-thermal techniques like adhesive (cyanoacrylate) or mechanochemical ablation. The appropriate combination is decided after evaluating your vein map and lifestyle together.

Common Misconceptions

The concern that “blood will remain in the leg if the vein is closed” is incorrect; the problematic superficial vein is closed, and blood is redirected to deeper, healthier veins. Saying that “varicose veins will disappear completely” is also not realistic; the closed vein will not reopen but time can bring about problems in other segments. This is why lifestyle measures such as weight control, regular walking, and compression stockings if needed, are important.