This form of vein treatment is named as such because there is only a small single cut per vein treated in contrast to the conventional and now outdated, “Stripping” procedure of old, which has a recurrence rate of 20% – 50%, and which in my opinion should almost never be needed.

There are a variety of minimally invasive vein treatments:

  1. Radiofrequency ablation – the VENEFIT procedure
  2. Endovenous laser treatment – EVLT
  3. Clarivein ablation
  4. Glue – VENASEAL procedure
  5. Ultrasound guided sclerotherapy

Our preferred method of treating the refluxing vein is with Radiofrequency ablation (RFA) – a method, which is essentially the same as the laser procedure with the main difference being that it is less painful for the patient post-operatively. However the specific method of treatment is based upon each individual’s specific condition.

Should I do it:

The decision as to do a procedure on your veins rests entirely upon you. Vein treatment is not like that of the arteries, wherein if you don’t treat them a major problem will ensue or that if you don’t treat them early, a bigger procedure will be needed. This is rarely the case with the treatment of veins, although there is some data to show a slight increase in DVT in patients with varicose veins.

The treatment of veins can be important for serious conditions such as ulcer (break in the skin) recurrence, but also is a quality of life issue and not necessarily a “cosmetic” issue. In fact our practice is NOT to treat the inside (GSV / SSV) veins for asymptomatic or purely cosmetic reasons as this same vein can be used in the future for other heart or vascular procedures – much like having a spare body part for an unforeseen event.

In light of this, one has to make a decision driven primarily by the symptoms. If one has heaviness, swelling, pain or darkening of the skin at the level of the ankles / feet, especially after long standing (in the evenings) and relieved with leg elevation and hence much reduced in the mornings, then it is possible that veins are an issue and should be investigated.

Investigation’s for veins are primarily with an ultrasound (see Vascular Ultrasound) which takes about an hour and is done in a standing position. The test to be done in a “standing” position is critical to duplicate conditions which cause symptoms with veins. This is because standing shows the effect of gravity and is a “stress test” for the veins.

  1. I have decided to go ahead with the procedure –

2 – 3 days before:

You shall receive a call to discuss the timing, location as well as prior preparation for the procedure. If you have remaining questions, please address them with the caller, or else please e-mail: doctor@vascular.ae

Day of treatment – BEFORE you come to the hospital:

  1. You will need to stop eating and drinking 6 hours before your scheduled time of arrival at the hospital. The procedure is to be done under local anesthesia with sedation and for the sedation we would like to ensure that your stomach is empty at the time of the procedure.
  2. When you arrive, please head to the main reception and state that you are here for an operation by Dr. Amit Kumar. They will then direct you to the appropriate destination.
  3. Once registered, you shall change into a hospital gown. They will also place a hospital ID band on your wrist.
  4. Prior to being taken into the Operating room, you shall also receive an injection of Enoxaparin in your stomach or thigh. This is to prevent a blood clot (DVT) from forming in the main veins.

Day of treatment:

You would have received a call , typically 2 days prior (Abu Dhabi), confirming your time to arrive at the hospital.

Stay without food and water for 6 hours before the operation.

If you are flying in from outside of the UAE, please let us know at the time of confirmation of the operation so that we can assist you in making necessary hotel reservations.

Please take all your medications which you take routinely at home and at the same times, INCLUDING, Aspirin and Plavix. Take these medications with a few sips of WATER. These medications are important and must be taken on time. The only medications which you SHOULD NOT take are:

  1. Diabetic medications – alternatives shall be discussed at the time of your clinic visit when you book for the operation
  2. Blood thinners – Warfarin / Coumadin, Xarelto, Dabigatran, Clexane / Enoxaparin

In the hospital:

Come to the Main Hospital reception and they shall show you the way to the Operating Room (Abu Dhabi) or your inpatient room (Dubai).

In the room, you shall change into a hospital gown and have the following performed:

  1. Hospital ID placed on your wrist
  2. IV cannula placed in the hand
  3. Marking of the side on which the operation is going to be done as well as the map of the vein made BEFORE you go into the Operating room.
  4. Till such time you are being wheeled into the Operating Room your family is welcome to stay with you as per the hospital policy.
  5. NO family member can be in the Operating room as it affects your operation – it’s safety and sterility.

In the operating room:

You will be asked to move from the bed to the operating room table.

Once there a few stickers and wire (EKG leads) will be placed upon your chest and back to monitor your heart rate, blood pressure and oxygen saturation.

This will allow them to give you some medicines to make you a bit sleepy (sedation). This will allow you to be comfortable while we prepare your legs for the procedure.

Preparation includes exposing the body below the waist. The privates are covered up as soon as they have been prepared. We try our best to ensure that this part is done with the utmost discretion and decency possible. Parts that are in the field and affect the sterility of the operation have to be prepared for this reason. During this part, your legs will be lifted up so that they can be cleaned all around (circumferentially). Next the drapes are placed and the procedure performed.

After this you will be transferred to the Recovery room to make sure you are comfortable after the procedure and the blood pressure, heart rate and oxygen saturation are stable.

Once all of these are confirmed, you shall be transferred back to the place where you came to prior to the operation.

Family should anticipate you’re being gone for about 2 – 3 hours from the time you go into the operating room – your legs have to be prepped (cleaned aseptically), the procedure has to be done ( 30 minutes – one leg; 1 hour – both legs), you have to recover from the sedation ( sleeping medicine) ~ 1 hour, etc.

Finally you will be brought to the cubicle / room from where you shall change and go home. In this cubicle / room you can stay till you feel comfortable in walking, eating and pain free.

After going home on the same day:

Try to walk around as normally as you can.

Feel free to perform any of the exercises you feel comfortable performing

Do not drive your car on that day – you would have received sedation.

Keep the stockings on till the next morning.

If you find bleeding from the incision, apply direct pressure for 20 minutes.

If the dressing needs to be changed, use clean hands to remove the dressing and once pressure has been applied and no more oozing is seen, you can apply a band aid on the incision.

For pain, you can use Panadol 1 gram as needed every 6-8 hours by mouth. A prescription will be given to you at the time of booking the operation.

The next day:

Remove all the stockings

Remove all bandages EXCEPT a semi-transparent strip right on the incision. This can be left on and it shall peel away by itself over the next few days.

You can shower and scrub the leg as usual with soap and water.

Continue to exercise as normal.

Bruising along the site of the injections can happen and shall disappear within a week or two.

First week:

The bruises along the inner thigh (from the injections) shall start to disappear.

You might find stiffness along the line of the vein (inner thigh or the back of the calf) which will resolve often times within a few days, but sometimes longer.

If you may find numbness along a strip of skin on the inner lower leg or on the back of the calf – this typically will resolve by itself in most cases over the next few weeks to months

A follow up visit in the clinic shall be scheduled to confirm that all is well. At that visit a repeat ultrasound shall be scheduled (after insurance approval) which will confirm that the procedure was successful.

Over the next 6 weeks:

The leg should continue to return to normalcy with each passing day.

The veins should also start to resolve over the next 6 weeks.

At 6 weeks:

You should plan to follow-up in the clinic to have a repeat ultrasound done – this will be scheduled by the coordinator / nurse at the time of your first visit after the procedure.

Follow -up:

Typically we shall see you back in 6 months and annually thereafter for a clinical assessment as well as an ultrasound to ensure continued resolution of the vein and the symptoms.

 

Disclaimer:

These are general guidelines for the Radio Frequency Ablation (Venefit) procedure that we follow. Each of us is different and hence the specific plan might be different in your particular case. If any clarification is needed, please contact:

 

doctor(at)vascular.ae