Endovenous Thermal Ablation (EVTA) is an advanced medical procedure that uses catheter technology to treat varicose veins in the lower limbs. Its core principle involves applying thermal energy directly to the diseased vein wall, causing the vessel to contract and ultimately close. This therapy primarily targets venous reflux in the deep veins of the lower limbs, effectively improving blood pooling and related symptoms such as leg swelling, pain, and skin ulcers. Compared to traditional surgery, EVTA offers advantages such as minimal trauma and shorter recovery times, making it one of the preferred treatments in modern vascular surgery.
Endovenous thermal ablation mainly includes two techniques: Radiofrequency Ablation (RFA) and Endovenous Laser Treatment (EVLT). Both require ultrasound guidance to insert the catheter into the target vein. RFA uses electromagnetic waves to heat the vessel wall to 60-120°C, while laser therapy utilizes light energy to generate heat. When the vein temperature exceeds 60°C, collagen contracts and forms a permanent closure, blocking blood reflux and promoting healthy vein drainage to restore normal blood flow.
This therapy is suitable for patients with Chronic Venous Insufficiency (CVI), especially for severe varicose veins caused by reflux in the great saphenous vein or small saphenous vein. Indications include:
The procedure is performed in outpatient clinics or day surgery units under local anesthesia. A puncture is made on the inner thigh to insert the catheter into the target vein. The heating time is adjusted based on the length of the vessel, typically 10-15 minutes per centimeter. The treatment duration is about 1 hour, and patients are advised to wear compression stockings for 4-6 weeks post-procedure to maintain the treatment effect. Dose control is adjusted according to the vessel diameter, generally suitable for main veins with a diameter of over 4mm.
The key advantages of this method include its minimally invasive nature, with only a 0.5cm puncture site, significantly reducing infection risk. Patients can resume normal activities the day after treatment, with recovery times shortened by over 70% compared to traditional stripping surgery. Additionally, ultrasound guidance allows precise localization of the diseased vessels, with a treatment accuracy rate of up to 95%. Clinical studies show that 85% of patients experience significant symptom improvement at 6 months, with a recurrence rate of less than 10% after 5 years.
Main risks include:
Contraindications include coagulation disorders, active infections, and severe cardiopulmonary diseases. Preoperative venous ultrasound assessment of vascular anatomy is essential. Pregnant women and patients with cardiac pacemakers should avoid this procedure. Postoperative care involves strict adherence to medical instructions, such as avoiding prolonged standing and regular ultrasound follow-up.
This therapy can be combined with sclerotherapy, minimally invasive phlebectomy, and other treatments to form a multi-layered approach. When used with oral anticoagulants, dosage adjustments and extended observation periods are necessary. For patients undergoing radiotherapy or chemotherapy, vascular wall metabolism should be evaluated before determining the appropriate treatment timing.
Randomized controlled trials show that 12 months after RFA, 90% of patients maintain permanent vein closure. Compared to traditional surgery, post-treatment pain scores are reduced by 40%, and patient satisfaction increases by 65%. Long-term follow-up over 5 years indicates re-canalization rates of approximately 6-8%, mainly occurring in untreated collateral veins. The efficacy is directly related to vessel diameter, patient activity levels, and postoperative care.
Although traditional great saphenous vein stripping provides stable results, it requires general anesthesia and a longer recovery period. Sclerotherapy is suitable for superficial veins with a diameter less than 3mm but may cause pigmentation. Newer techniques such as radiofrequency microinvasive procedures (Venefit) and EVLT differ in their principles and should be selected based on vein location and patient condition. Emerging ultrasound ablation techniques are still in clinical trials and have not yet been widely adopted.
It is recommended to stop anticoagulants (such as aspirin) or herbal supplements two weeks prior to treatment to reduce bleeding risk. The doctor will evaluate whether to adjust medications for chronic conditions based on the patient’s health status and advise avoiding alcohol and keeping the legs clean before surgery.
How can I relieve leg swelling or pain after treatment? Do I need special equipment?Minor swelling or tenderness may occur within 48 hours after treatment. Wearing the prescribed medical compression stockings (pressure level 15-20 mmHg) and elevating the limb can promote blood flow. If pain is significant, analgesics can be taken as directed, but hot compresses should be avoided unless approved by a physician.
When can I resume daily activities? Will it affect my work schedule?Most patients can walk on the day of treatment, but should avoid lifting heavy objects or standing for long periods for at least one week. For light activities, recovery usually occurs within 1-3 days; for high-intensity work, individual adjustment in consultation with the doctor is recommended.
Will varicose veins recur at the same site after treatment? How can recurrence be prevented?The recurrence rate at the same site is less than 5%, but other veins may be affected. Key preventive measures include continued use of compression stockings, avoiding prolonged standing, regular ankle movements to promote circulation, maintaining a healthy weight, and quitting smoking. Follow-up ultrasound examinations will be scheduled by the physician.
How do the long-term efficacy and complication rates of RFA compare to traditional surgery?Five-year success rates of RFA reach 85-90%, with fewer complications such as bruising or transient nerve irritation compared to traditional surgery. Its minimally invasive nature reduces tissue damage, but individual differences may influence outcomes. Lifestyle adjustments are necessary to prolong the benefits.
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