Having a non-surgical procedure for varicose veins

This page explains more about the non-surgical treatment options for your varicose veins. 

Radiofrequency ablation (RFA)

This is also known as endovenous ablation technique. The procedure usually takes around 30 minutes. This is a method of closing off the vein that is feeding your varicose veins using heat. RFA is performed under local anaesthetic, which numbs a specific area of your body but does not put you to sleep. You recover faster and avoid many of the risks associated with having a general anaesthetic.

During the procedure, the surgeon numbs your skin with the local anaesthetic. Then makes a small (2mm) cut (incision), usually near your knee or on your calf. Using ultrasound for guidance, a narrow tube, called a catheter, is put into the vein that needs treating. 

A fine probe is then passed through the catheter and inside your vein. Local anaesthetic is injected around the vein. The catheter is activated and powered by radiofrequency (RF) to deliver heat to the vein wall. The vein wall shrinks and the vein is sealed closed. The catheter is slowly removed and an ultrasound scan checks that the procedure has been successful. 

A small dressing and a bandage will be placed over the small cut, and a compression stocking will be applied.

Ultrasound-guided foam sclerotherapy (UGFS)

Sclerotherapy involves injecting an irritant substance (called a sclerosant) into the veins to shrink and seal them off. The procedure itself usually takes only a few minutes and is done without anaesthetic.

The sclerosant is mixed with air to create foam so that it can be seen using an ultrasound scanner. Guided by the ultrasound scanner, the foam is injected into the vein that is causing the varicose veins.

A small dressing or a pad and bandage will be placed over the injection site to squeeze the treated vein flat and a compression stocking will be applied.

Giving your permission (consent)

We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you understand what it involves and agree to have the treatment.

You can read more about our consent process.

Risks and possible complications after RFA and UGFS

As with any procedure, there is a risk of you having a medical complication. Your doctor will go through all the risks with you before you sign your consent form.

The more common surgical risks include:

Common problems

• Most people feel a tightening along their leg after the procedure.
• Once the local anaesthetic wears off, there may be some pain and bruising along the line of the treated vein. The bruising will disappear after a few weeks.
• About 1 in 10 patients develop swelling (inflammation) causing discomfort and lumpiness around the vein. This is called phlebitis. This usually settles down without treatment, but anti-inflammatory painkillers may help. It may also leave some brown staining on your skin when the swelling has reduced. This staining fades over time, but it can also be permanent. To minimise the chances of phlebitis, it is important that the vein is squeezed empty after the procedure. For this reason, you will need to wear compression stockings.
• Varicose veins can come back after all types of procedures. The underlying weakness in the vein valves may result in other veins causing further varicose veins in the future, even when all previous veins have been treated correctly.

Rare problems

• Deep vein thrombosis (DVT) is a rare complication of any operation to the legs. DVT is a blood clot that develops within a deep vein in the body, usually in the leg. To lower the risk of developing DVT, you will be advised to return to walking normally after your treatment. Walking keeps your blood flowing in the important deep veins, whereas being inactive can increase your risk of DVT.
• There is a small risk of damage to other veins and nerves, which may result in numb patches of skin or tingling. This normally diminishes with time.
• Burns to your skin are possible after RFA, but very rare.
• Any operation that involves a cut to the skin carries a risk of infection. As RFA involves a very small cut, this risk is rare.
• Allergic reactions can occur shortly after injections of sclerosant, but are rare.

Leaving hospital after RFA or UGFS

About 30 minutes after your procedure, you will be able to walk out of the hospital. 

You should not drive.

Over the following days the body reacts to the damaged vein by causing swelling and absorbing the tissue in the vein. This makes sure that the vein stays closed.

Pain

The leg is usually more uncomfortable the day after the procedure. Pain is unpredictable and varies from person to person. You may need to take painkillers for a few days after the procedure. Always follow the instructions on the packet. 

Swelling

Your leg may be slightly swollen after RFA. If you develop phlebitis, the pain may last up to 3 or 4 weeks. Anti-inflammatory painkillers will help until it settles down on its own.

Compression stocking

You should wear the fitted compression stocking for a further 2 weeks. It should stay on at all times for the first 48 hours. After that, you may remove it to have a shower or bath. You do not need to wear it when you go to sleep.

The stockings may be uncomfortable and difficult to get on and off, but it is important to get them on correctly to get the most benefit from them. They are supposed to be tight and you may need someone to help you put them on and take them off.

To help get the stocking on, you can try sliding your foot into a small plastic bag. Grasp the top of the stocking, slide the stocking over the plastic bag and up the leg, smoothing it out evenly and making sure that it is not twisted or stretched too much. Pull the plastic bag through the open toes to remove it. Pull the stockings all the way up so the correct level of compression is applied to each part of your leg.

Do not allow the stockings to roll down as they can form a tight band and dig into your skin. For the best results you should wear your stockings for the full 3 weeks but if they become very uncomfortable and painful, you can stop wearing them.

Please do not throw away the stockings as you may need them later if you get pain.

Walking

It is a natural reaction to limp when your leg is painful. Your muscles, bones and joints are not affected by varicose veins treatment, so you need to walk as normally as possible. Walking keeps your blood flowing in the important deep veins. Being inactive can increase your risk of DVT. 

As a minimum, we recommend 20 minute walks, 3 times a day, every day after your procedure.

Regular daily exercise, such as walking or using an exercise bike, and wearing your stockings for a few more days may help with the pain and bruising.

Flying

You should not fly due to the increased risk of getting a DVT.

We recommend that you avoid short haul flights (less than 4 hours) for 2 weeks.

Long haul flights (more than 4 hours) should be avoided for 4 weeks.