A relatively new procedure (RF approved by the FDA in 1999, LASER 2001) is endovenous closure. This procedure uses either radiofrequency energy or LASER energy delivered through a thin catheter to treat the underlying cause of the varicose veins. Performed with ultrasound guidance and under local anesthesia, this process is a gentler, minimally invasive approach to the treatment of the underlying insufficient veins causing the varicose veins or other presentation of venous insufficiency such as swelling, skin discoloration, bleeding or ulceration. Endovenous closure or ablation allows treatment of leaking veins by sealing them with heat, rather than stripping the veins out of the leg. With endovenous closure, there are no incisions, minimal to no pain, and minimal scarring.
Endovenous closure involves the placement of a thin catheter into the faulty or leaky vein through a small needle hole, under local anesthesia, in an outpatient setting. Once the leaking vein is closed, the tortuous varicose veins will often depressurize and shrink. Some varicosities will completely disappear. In other cases it may be necessary to remove the residual bulging veins either in conjunction with the endovenous closure procedure or at a subsequent procedure. This can easily be accomplished through tiny incisions, again under local anesthesia, in an outpatient, office setting. The sealed vein is permanently closed off to any future blood flow, and the body will naturally use other healthy veins to return blood to the heart. In fact, the body’s “circulation” will be improved after a severely leaky vein is sealed since normal veins will not be overwhelmed with the job of returning the extra pooling blood from the leaky vein. The majority of patients with advanced venous disease can be treated with endovenous closure alone and can return to normal activity almost immediately. Endovenous closure can be performed in a physician’s office under local anesthesia, with long-term success exceeding 95%.