Endovenous ablation with either laser or radiofrequency, has largely replaced the traditional surgery (vein "stripping") in the management of venous insufficiency. It is usually used for the great or small saphenous veins, or any other superficial vein that may be insufficient. Both laser and radiofrequency ablation are essentially similar procedures with similar outcomes and risks.

Overall they are highly effective with minimal complications. No incisions are required and they can be done in an office environment. Endovenous laser ablation should not be confused with the skin laser done for spider veins. Endovenous ablation targets the larger veins that are feeders of the spider veins.

Using real-time ultrasound guidance, the diseased vein is identified and a catheter is inserted into the vein through a puncture. Local anesthesia is injected around the vein, first isolating it from surrounding tissues and, then, making vein area numb. Once the anesthesia has reached the vein, the laser or radiofrequency is activated and heats (ablates) the vein from inside. The leg will be then placed into compression stocking or wrapped with multilayer compression which you need to keep continuously for 48 hours and then daily for 2 weeks (no need to wear them during the night sleep). You may walk out of the office within 2-3 hours and resume your activities immediately.

Endovenous ablation

The ablated vein will gradually clot, harden, shrink and disappear. The blood will continue to flow through the other healthy veins of the leg. You will need to return to your vascular surgeon's office in 2 weeks for reassessment and to continue with sclerotherapy as needed.

Endovenous ablation therapies, as all medical interventions, carry some risks, rare (approximately 1%) but sometimes can be quite critical: skin discoloration, skin burn or necrosis that will heal overtime and deep venous thrombosis.