What it is for
Radiofrequency ablation treats the cause of most varicose veins and most chronic venous insufficiency: a vein — usually the great or small saphenous — whose valves have failed, letting blood fall back down the leg and build pressure in everything below it.
Treating the visible veins while that vein continues to reflux is treating the symptom. Closing the refluxing vein is treating the problem.
What happens
The leg is scanned to locate the vein and confirm the plan. A small amount of local anaesthetic numbs the skin, and a thin catheter is passed into the vein through a single needle puncture. More local anaesthetic is then placed in the tissue surrounding the vein along its length — this both numbs it and protects the surrounding structures from the heat.
The catheter delivers controlled radiofrequency energy segment by segment, heating the vein wall so that the collagen contracts and the vessel seals shut. The catheter is withdrawn as it goes. There are no incisions and no stitches — a small dressing covers the entry point.
The whole appointment is about an hour. You stand up, put on a compression stocking, and walk out.
Afterwards
You walk that day and every day. Compression stockings for the period Dr. D’Alessio specifies. Desk work is generally fine the next day. Heavy lifting, strenuous exercise, hot baths and saunas wait a short while.
Expect some tightness, a cord-like feeling along the treated vein, and bruising, all of which settle over a few weeks. The relief of heaviness and aching often comes earlier than the change in appearance, because it comes from the pressure dropping, and that happens straight away.
Why it replaced surgery
Vein stripping meant a general anaesthetic, incisions in the groin and the leg, and a recovery measured in weeks. Endovenous techniques such as radiofrequency ablation achieve at least as good closure rates through a needle, under local anaesthetic, in a treatment room. This is now the standard of care, and it is the reason nobody at this practice will suggest stripping your veins.
Is it right for you?
That is decided by the duplex ultrasound map, not by how the leg looks. Where the vein is long and reasonably straight, radiofrequency ablation is usually the right tool. Where it is tortuous or awkwardly branched, Varithena® microfoam often fits better. Surface branches are dealt with afterwards by sclerotherapy. The map determines which, and it is explained to you before anything is scheduled.