Minimally Invasive Varicose Vein Treatments

Minimally invasive varicose vein treatments are methods based on closing the vein from the inside with modern interventional techniques, without the need for a surgical incision, for patients whose veins have become enlarged. Unlike traditional approaches, the problem vein is left in the body and sealed by thermal or chemical means. Made possible by advancing technology, these solutions are among the comfortable varicose vein treatment options that can be carried out without disrupting the patient’s daily life.

When the valves in the venous system fail, blood flows backwards under gravity, the vein walls stretch and varicose veins form. Minimally invasive methods take these enlarged, non-functioning veins out of circulation so that blood flow is redirected into healthy veins. The techniques used in this process are described as minimally invasive and can greatly reduce the need for a long hospital stay. The main aim of treatment is not only to address cosmetic concerns, but also to bring the symptoms of chronic venous insufficiency, such as pain, swelling and a feeling of heaviness in the legs, under control.

What is minimally invasive varicose vein surgery?

Minimally invasive varicose vein surgery is the general name for the treatment methods known in the medical literature as endovenous procedures, which allow the vein to be treated from the inside without making large scalpel incisions in the skin. The basic principle is that, rather than surgically removing the diseased vein from the body, the lumen of the vein is shrunk and completely closed using heat energy or special medical agents. After the procedure, the closed vein is gradually absorbed by the body through a natural process and disappears.

This treatment approach uses technological equipment such as laser fibres or radiofrequency catheters. Adapted to cardiovascular surgery from the discipline of interventional radiology, these techniques make it possible to reach the target area without damaging the anatomy of the vein. Because access to the vein in minimally invasive methods is through a hole no larger than the tip of a needle, no stitches are needed and the integrity of the skin is largely preserved. This limits tissue trauma and makes the recovery process more predictable.

One of the notable features of the procedure is that it allows the effect on the nerve and lymphatic tissue around the vein to be minimised. As no surgical incision is made, the risk of infection is kept under control and tissue tenderness is low. This allows patients to get up immediately after the procedure and return to their normal activities within a short time. These techniques offered by modern medicine have turned varicose vein procedures into medical procedures that follow a defined standard and controlled steps.

How do endovenous laser and radiofrequency methods work?

Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) work through a physical mechanism in which heat energy is applied in a controlled way to the inner wall of the diseased vein, causing it to shrink and close. The basic aim is the same in both methods: to affect the collagen fibres in the vein wall with the right amount of heat, narrow the diameter of the vein and create a seal that no longer leaks blood. In the laser method, light energy is delivered into the vein through a fibre-optic cable, while the radiofrequency method uses high-frequency radio waves delivered through the tip of a catheter.

Once the laser fibre has been placed inside the vein, the device is activated and heat is distributed along the vein as the fibre is slowly withdrawn. This heat produces a controlled change in the inner lining of the vein. As a result, the vein walls stick together and the vein closes. In the radiofrequency method, the tip of the catheter touches the vein wall and heats the vein segment by segment at a set temperature as it moves along. Both technologies stop the flow of blood inside the vein and automatically redirect it to the deeper, healthy veins.

The technical details and differences in application are assessed by the physician according to the diameter and tortuosity of the patient’s veins. Laser may sometimes be preferred for wider veins, while radiofrequency, which provides uniform heat control, can offer an advantage in some cases in terms of protecting the surrounding tissue. Because the devices used during the procedure can track the energy delivered to the vein wall to the millimetre, the likelihood of unwanted heat damage to the surrounding tissue is very low.

What are the stages of an endovenous procedure?

The interventional varicose vein treatment process begins with a detailed Doppler ultrasound examination of the patient in the standing position, which maps the veins. After the patient’s skin has been sterilised in the procedure room, the problem vein is accessed with a needle under ultrasound guidance. A thin guide wire is advanced from the entry point, and over this the laser fibre or radiofrequency catheter is positioned at the starting point of the vein, usually in the groin or behind the knee.

Once the catheter is in place, a special form of local anaesthesia called tumescent anaesthesia is applied. Injected around the vein under ultrasound guidance, this fluid mixture helps to prevent pain during the procedure, protects the tissue around the vein from the heat delivered and compresses the vein to improve its contact with the catheter. Thanks to this anaesthetic technique, the aim is to complete the procedure without the need for general or spinal anaesthesia.

After the anaesthesia is complete, energy delivery begins and the catheter is withdrawn at a set speed, closing the vein along its entire length. All of these stages are monitored in real time on the ultrasound screen, which allows the procedure to be carried out with a high degree of precision. After the catheter is removed from the vein, a small dressing is applied to the entry point; stitches are generally not required. Compression stockings are put on while the patient is still on the procedure table, and after a short rest the patient is asked to walk.

Who is suitable for minimally invasive varicose vein treatment?

The most suitable candidates for minimally invasive methods are people in whom colour Doppler ultrasound has identified venous insufficiency in the great or small saphenous veins. The criteria the physician considers at the examination include a vein diameter within treatable limits, a vein that is not excessively tortuous, and no history of clotting that would stand in the way of the procedure. This method is designed to eliminate the main vein reflux that is the underlying source of swelling and pain in the legs.

These techniques have become the preferred option for people with an active lifestyle and for those who want to return to work quickly. For those active in disciplines that demand physical performance in particular, it is a significant advantage to be able to recover without long convalescence, in line with the principles of vascular health for athletes. In older patients or those who are not suitable for general anaesthesia, these methods, which can be performed under local anaesthesia, may be considered by the physician as an alternative treatment option.

Not every patient with varicose veins is suitable for endovenous methods, however. For example, cases in which the vein has become so enlarged that it is aneurysmal, or the presence of extensive old clots inside the vein, may lead the physician to other solutions. The decision on suitability is made by a specialist physician after a comprehensive assessment of the patient’s anatomy, the severity of their symptoms and the Doppler ultrasound findings.

How long does the procedure take?

Varicose vein procedures carried out with endovenous techniques generally take a total of 1 to 1.5 hours, including preparation and the procedure itself. The technical part of the procedure alone takes around 30 to 45 minutes on average for a single leg. However, the patient’s arrival at the clinic, ultrasound marking of the veins and the local anaesthesia stages are additional factors that determine the total time.

One of the main factors affecting the duration of the procedure is the number of veins to be treated. In some cases there may be main vein insufficiency in both legs, or more than one branch may need to be treated in the same leg. It is possible to close more than one vein in the same session, but this will naturally extend the duration. In addition, if the enlarged surface branches are to be cleared at the same time as the main vein is closed, the time is planned accordingly.

The total length of stay at the clinic, including the follow-up period after the procedure, is approximately 3–4 hours. Patients are usually kept under observation for a while after the procedure and are then asked to get up and walk. If no complications develop, the patient can be discharged the same day. As no general anaesthesia is used there is no recovery from anaesthesia, which adds to the patient’s comfort.

How does recovery progress?

Recovery begins very quickly after the procedure, and patients can walk out of the clinic on their own immediately afterwards. A mild ache or a feeling of fullness in the leg within the first 24 hours is considered normal; it does not usually prevent routine daily tasks. Most patients are expected to return to work and social activities the day after the procedure.

Wearing a bandage or compression stockings after the procedure is part of recovery. The leg is usually kept bandaged or the stockings kept on for the first 24–48 hours; after that, on the physician’s advice, the stockings continue to be worn for a few weeks during the daytime only. This applies pressure over the closed vein, supports healthier healing and can reduce swelling. The needle entry points in the skin close within a short time and the risk of a noticeable scar is low.

Mild bruising on the leg and a feeling of firmness along the line of the treated vein usually subside on their own within 10 to 15 days. Full recovery and the final appearance of the leg can take some time, depending on how quickly the body absorbs the closed vein. Patients are advised to stay active during this period. The comfort provided after the procedure is an important factor in helping patients continue their daily lives without interruption.

What should you pay attention to after the procedure?

The most important rule after modern varicose vein procedures is to avoid staying still and to start regular exercise programmes under medical supervision straight away, particularly brisk walking. Walking works the leg muscles, supports blood flow and helps reduce the risk of clots forming in the deep veins. Patients are usually advised to take short walks at least twice a day.

For the first few weeks after the procedure, strenuous sports and weightlifting exercises that put excessive load on the legs should be avoided. Because exposure to high temperatures can cause the veins to dilate, it is also helpful to avoid activities such as hot baths, Turkish baths, saunas and prolonged sunbathing for the first 15–20 days. A warm shower is generally considered safe after a certain period, but this period is determined by the physician according to the technique used.

In terms of wound care, the need for dressings is minimal as there are no stitches; it is enough to keep the dressings at the entry point clean. Creams recommended by the physician can be used for any mild discolouration of the leg. As smoking can slow tissue healing, limiting it during this period is advised. If a journey involving a long period of immobility, such as a flight, is planned, the physician should be consulted and additional precautions taken if necessary.

What are the possible risks of the procedure?

As with any medical procedure, endovenous varicose vein treatments have some possible side effects, but these are generally temporary. The most common include mild tenderness along the path of the vein, a feeling of tightness and bruising of the skin. In some patients, the heat energy can affect nearby nerve fibres, causing temporary numbness or tingling in certain areas of the leg; this usually resolves over time.

The most serious risk, although rare, is deep vein thrombosis, that is, a clot forming in the deep main veins. To minimise this risk, careful ultrasound monitoring is carried out during the procedure and the patient is asked to walk immediately afterwards. Patients in risk groups may sometimes be prescribed short-term preventive treatment. In rare cases, heat-related discolouration of the skin may occur, but this risk has been greatly reduced with current technology.

The medical conditions that can accompany varicose veins and the possible side effects of the procedure are clarified through a comprehensive assessment by a specialist physician. A thorough examination is essential in order to determine the treatment method. Suitability and the treatment plan are confirmed by Op. Dr. Arzu Ercan on the basis of a physical examination and Doppler ultrasound findings.

Frequently Asked Questions

Is there any pain during minimally invasive varicose vein surgery?

Thanks to the local anaesthesia applied to the treatment area, no significant pain is expected during the procedure; only a mild feeling of pressure may be felt while the anaesthetic fluid is being injected or while the vein is being treated along its length.

Will there be a noticeable scar on the leg after the procedure?

Because no surgical incision is made and the vein is accessed only through a hole the size of a needle tip, no stitch marks are expected after the procedure. The entry point usually blends in with the skin colour within a short time and becomes barely visible.

Do varicose veins come back after minimally invasive treatment?

As the treated vein is completely closed, varicose veins are not expected to recur in that vein; however, depending on a person’s genetic make-up or lifestyle, there is always a possibility that new varicose veins will develop in other veins over time.

Sources

• Varicose Veins Treatment — NHS
• Varicose Veins Overview — Society for Vascular Surgery