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Maged S.Mikhail, M.D, R.V.T.
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Endovenous Ablation

This procedure is a major advance in the treatment of varicose veins because it:

  1. Requires only local anesthesia
  2. Immediately relieves symptoms
  3. Results in minimal pain or discomfort
  4. Allows patients to immediately get up, walk, and resume normal activity
  5. Results in no scarring
  6. Long term results are the same or better than surgery
  7. Provides new treatment options for patients with recurrent varicose veins
  8. Allows treatment of patients who previously could not tolerate surgery or anesthesia.

How is Endovenous Ablation Performed?
During endovenous laser ablation a very small laser fiber is placed into the diseased vein through a slightly larger small intravenous catheter. The ablation catheter is then positioned precisely with ultrasound. A local anesthesia solution is injected around the vein to make ablation painless and protect surround tissue. The heat generated during catheter activation permanently closes the vein and functionally removes it from the circulation. Endovenous laser ablation has only a 5-10% long-term (after 3 years) failure rate compared to the 20-40% short and long term failure rates that have been reported following surgical ligation and stripping.

Advantages of the 1320 nm CoolTouch® CTEV System over Other Endovenous Ablation Devices
  1. Less bruising
  2. Less pain
  3. Higher success rate
  4. Reduced risk of heat injury to adjacent tissue

Our center primarily uses the CoolTouch® 1320 nm endovenous laser, arguably the most effective and versatile system. It allows treatment of smaller and tortuous problem veins that can be difficult to treat with other systems. Other endovenous laser systems appear to be associated with more pain and bruising. The radiofrequency system (Vnus®) was the first endovenous ablation technique but long-term results with the first system though better than surgery were not as good as the CoolTouch® 1320 nm laser (Dr. Robert Weiss, Baltimore MD). Short term (1-2 year) results are better with the newer ClosureFast® radiofrequency system but many doctors are concerned about its safety, and there is a relatively high number of adverse events reported to the FDA with this system ( The major advantage of the new radiofrequency system appears to be a slightly shorter treatment time for the busy doctor and higher physician reimbursement (

Risks of Endovenous Ablation
Serious complications from this procedure are very rare at experienced vein centers. Heat from the ablation catheter can cause temporary skin redness, minor skin burns or a small area of temporary numbness near the treated vein. The most serious potential risk is the rare formation of a clot in the proximal 1-2 cm remnant of the closed vein. That clot can extend into the deep venous system and may dislodge, traveling into the lungs (pulmonary embolism). A follow-up ultrasound examination is routinely performed after endovenous ablations to exclude this possibility. If a clot is detected a blood thinner can be given to dissolve it and prevent its migration to the lungs. The incidence of deep vein thrombosis is less than 1% after endovenous ligation and appears to be the same as that following vein ligation and stripping surgery.

ClosureFast® and Vnus® are trademarks of the Vnus® Medical Technologies, Inc.
CoolTouch®, is a trademark of the CoolTouch® Corporation

Before & After
The Los Angeles Varicose Vein Center is one of few clinics in Southern California that specialize in minimally invasive treatments for varicose veins.
We offer expertise in problems ranging from complicated cases, such as recurrent varicose veins after stripping surgery, perforator vein reflux, and advanced chronic venous insufficiency to simple cosmetic spider veins.
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