When Should You Refer Patients For Venous Ablation?
I often have patients at the wound center who get referrals to me for care after a venous ablation procedure. I researched the procedure to explore what is involved and when we should be referring patients to a vein clinic or a vascular surgeon.
In order to understand what venous ablation entails, we need to review the nature of venous insufficiency. Chronic venous insufficiency is the cause of many chronic ulcers in the lower extremity. The venous system is made up of both the superficial and deep vein system. These systems are connected by perforating veins as well as the great saphenous vein and lesser saphenous vein. Failure of the one-way valves separating both systems can lead to high pressures in the superficial systems, causing aching, which can lead to skin changes and ulcerations. As the valves are damaged, blood leaks and flows backward, causing the increased pressure in the vessels. Ulcerations occur in areas where blood collects and pools. As swelling occurs, this can interfere with the movement of oxygen and nutrients into the tissue.
The most common cause of ulceration in the lower extremity due to venous disease is the great saphenous vein area (medial ankle area). This problem is the cause of 60 to 80 percent of chronic leg ulcerations.1,2 The incidence of these ulcerations increases with age. Risk factors include: family history, sedentary lifestyle and jobs that require people to stand for an extended period of time.
The easiest way of treating venous insufficiency or reflux is compression therapy. If this does not help, venous ablation may be a good option.
Venous ablation is a non-surgical technique that has replaced vein stripping in most cases.3 Using only a local anesthetic, vascular surgeons can eliminate the abnormal refluxing vein by sealing it closed. The surgeon makes a small incision at the knee and places a small tube into the saphenous vein. Then he or she passes a laser or radiofrequency fiber through the tube into the vein. Once this fiber is in place, the fiber activates and delivers very localized heat to the vein wall. In response, the vein closes down and becomes permanently blocked.
If you have been seeing a patient for a venous wound and have been using conventional compression therapy without seeing wound healing in a reasonable timeframe or significant progress in four weeks, I suggest you consider a vascular consult or refer the patient to a vein clinic.
1. Whiddon LL. The treatment of venous ulcers of the lower extremities. Proc (Bayl Univ Med Cent). 2007;20(4):363-366.
2. New York-Presbyterian Hospital. Venous insufficiency and venous ulcers. http://nyp.org/services/venous-insufficiency-ulcers.html
3. Dotter Interventional Institute, Oregon Health and Science University. Venous ablation. http://www.ohsu.edu/dotter/venous_ablation.htm . Updated March 15, 2011. Accessed May 19, 2014.