16965 Endovenous Thermal Ablation

Overview

Endovenous thermal ablation is a small, keyhole procedure used to treat varicose veins. Varicose veins are swollen, twisted veins that often appear on the legs. They happen when tiny one-way valves inside the veins stop working properly, so blood pools instead of flowing back up towards the heart. 'Endovenous' means 'inside the vein', and 'thermal ablation' means using gentle heat to close the vein off. During the procedure, a very thin tube is guided into the faulty vein using an ultrasound scan for guidance. Heat is then applied to seal that vein shut. Once the vein is closed, blood naturally finds another route back up the leg, and the bulging vein shrinks over time.

Yes. Varicose veins are very common, affecting roughly one in three adults at some point. Endovenous thermal ablation is now one of the most widely used treatments for them, and it is recommended by UK NHS guidance as a first-line option when treatment is needed.

Varicose veins are more common in women than men, and become more likely with age. They often run in families and can appear during or after pregnancy, or in people who stand for long periods at work. They can affect younger adults too, and are uncommon in children.

Symptoms

Common symptoms

• Twisted, bulging veins that look blue or purple under the skin, usually on the calves, thighs or behind the knee
• Aching, heaviness or tiredness in the legs, often worse at the end of the day or after standing
• Swelling around the ankles, especially in the evening
• Night-time leg cramps
• Itchy, dry or thinning skin around the ankle
• Restless or uncomfortable legs that feel better when you put your feet up
• Small red or purple thread veins around the ankle

Symptoms in children

• Varicose veins are uncommon in children and teenagers
• If they do appear, it is usually because of a strong family history
• A single prominent vein, a vein that feels hard, or swelling in a child's leg should always be checked by a doctor

Symptoms in older adults

• Symptoms tend to build up over time, with heavier, more achy legs
• Skin changes are more likely — brownish staining, dryness or thinning skin near the ankle
• Leg ulcers (open sores) can develop, usually near the ankle, and can be slow to heal
• Swelling is more noticeable and may be mistaken for other causes of leg swelling

Causes

Main causes

• Faulty valves inside the veins, which normally stop blood from flowing backwards down the leg
• Weak vein walls that stretch and lose their shape, letting blood pool
• Increased pressure in the leg veins over time, often from standing for long periods

Risk factors

• A family history of varicose veins
• Being older — vein walls and valves weaken with age
• Pregnancy, when extra blood volume and hormones relax the veins
• Being overweight, which adds pressure on the leg veins
• Jobs that involve standing or sitting still for many hours
• Previous injury to the leg or a past blood clot in the leg veins

When to see a doctor

See a doctor urgently if:

• Sudden swelling, redness or pain in one leg
• Bleeding from a vein that keeps coming back
• A new leg ulcer, or a sore that is not healing
• Spreading redness, warmth or fever with leg pain

Book a routine appointment if:

• Aching, heaviness or tired legs that affect your day-to-day life
• Veins that are becoming more prominent or feel lumpy
• Skin changes such as brown staining, itching or dryness around the ankle
• You are unhappy with how your legs look and want to discuss options

Diagnosis

A doctor or specialist will usually start by looking at your legs and asking about your symptoms while you are standing. They will then arrange a painless ultrasound scan of the leg veins. This scan shows which valves are faulty and which veins are suitable for treatment, and helps plan the procedure.

Tests that may be done

• Physical examination of the legs, standing and lying down
• Duplex ultrasound — a painless scan that shows blood flow and valve function in the veins
• Blood pressure and pulse checks, and questions about your general health, as part of planning any procedure
• Occasionally, other tests if the leg is swollen, to make sure there is no blood clot or heart or kidney cause

What to expect at your appointment

The assessment is quick and painless. You may be asked to stand for a few minutes during the scan so the veins fill. If treatment is offered, you will be told about the benefits and risks and asked to give consent. You can usually bring someone with you and drive yourself home afterwards, but check this with your care team in advance.

Treatment

Treatment depends on how much your veins bother you. If symptoms are mild, simply wearing compression stockings, keeping active and raising your legs may be enough. If symptoms are troublesome or skin changes are developing, a procedure such as endovenous thermal ablation is often recommended. The aim is to close off the faulty vein so blood flows through healthier veins instead.

Self-care at home

• Keep moving — walking regularly helps the calf muscles pump blood upwards
• Put your feet up on a stool when resting, ideally above the level of your heart
• Avoid standing still for long stretches; shift your weight or walk in place if you must stand
• Wear compression stockings if your care team advises them, especially on long journeys or at work
• Keep the skin moisturised to reduce itching and dryness
• Avoid very hot baths or long hot soaks if your legs feel swollen

Medical treatments

Endovenous thermal ablation is done under local anaesthetic, sometimes with light sedation. A thin tube is passed into the vein under ultrasound guidance, and heat — from a laser or radio waves — seals the vein from the inside. Most people are up and walking within an hour and go home the same day, usually wearing a compression stocking for a short time. Other options include foam sclerotherapy, where a special foam is injected to close small veins, and 'avulsion' or 'stripping' surgery for veins that are not suitable for the keyhole approach. Your care team will discuss which option suits your veins best. You will usually be given advice about pain relief and about preventing blood clots after the procedure — ask your pharmacist or care team what is right for you.

When is surgery considered?

Traditional surgery may be suggested if the faulty vein is very close to the skin, is unusually large or twisted, or if keyhole treatment is not suitable for you. It is usually a day-case operation, but recovery takes a little longer than after thermal ablation.

Living with this condition

Most people recover quickly after endovenous thermal ablation. You can usually walk straight away, return to desk work within a few days and get back to more physical activity within one to two weeks — your care team will give you a personal plan. You may notice bruising or a pulling sensation along the treated vein for a few weeks, and the vein itself may feel firm before it gradually fades. This is a normal part of healing.

Lifestyle tips

• Build movement into your day — short walks, stairs and standing calf raises all help circulation
• If your job involves long periods of standing or sitting, take regular breaks to move your legs
• Raise your legs for 10 to 15 minutes when you get home
• Avoid tight clothing around the waist, groin or top of the legs, which can slow blood flow
• If you smoke, stopping is one of the best things you can do for your circulation

Diet and exercise

There is no special diet for varicose veins, but staying at a healthy weight reduces pressure on the leg veins. Plenty of fibre and water helps prevent constipation, which can add to pressure in the leg veins. Walking, swimming, cycling and gentle strength work for the calves and ankles are all excellent — they work the calf pump that pushes blood back up the leg. Avoid heavy lifting and long periods of high-impact exercise straight after treatment until your care team says it is fine.

Mental health and emotional wellbeing

Varicose veins can affect how you feel about your legs, and some people feel self-conscious in shorts or swimwear. Ongoing aching can also be tiring and affect sleep and mood. These feelings are common and worth mentioning — they are part of the reason treatment may be offered. If low mood, worry or body-image concerns are weighing on you, talk to your doctor, who can point you to support.

Prevention

You cannot always prevent varicose veins, especially if they run in your family. But you can reduce the pressure on your leg veins and lower the chance of them getting worse: stay active, keep to a healthy weight, avoid standing still for long periods, raise your legs when resting, and wear compression stockings if your care team recommends them. After treatment, these habits also help protect the other veins in your legs.

Screening programmes

There is no national screening programme for varicose veins. See your doctor if your legs ache, swell, or the skin around your ankles starts to change.

Complications

If left untreated

• Symptoms such as aching, heaviness and swelling may gradually get worse
• Skin around the ankle can become stained, dry, itchy and fragile — sometimes called varicose eczema
• Leg ulcers can develop and may take weeks or months to heal
• Inflamed veins (phlebitis) can cause a hard, tender, red cord under the skin
• Occasionally a varicose vein close to the skin can bleed
• Rarely, a blood clot can form in a deep vein, which needs urgent assessment

Long-term outlook

The outlook is generally very good. Endovenous thermal ablation works well for most people, with a high chance of the treated vein staying closed, and most people notice less aching and heaviness within a few weeks. Some people need a second treatment later, either for another vein or because a vein reopens. As with any procedure there are small risks, such as bruising, temporary numbness or minor skin irritation — your care team will explain these before you decide. Most people are back to normal activities quickly and are pleased with the result.

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