Healthy leg veins use one-way valves to help blood return toward the heart. When a superficial vein valve does not close properly, blood can flow backward and pool. This is called venous reflux and can contribute to enlarged veins, aching, heaviness, swelling, itching, or skin changes.
Why varicose veins develop
Family history, pregnancy, age, previous blood clots, and long periods of standing can influence venous disease. Symptoms often become more noticeable later in the day or after prolonged standing. Visible veins alone do not show whether an underlying vein is refluxing, and leg discomfort can have causes unrelated to the veins.
Compression, regular walking, leg elevation, and weight management may improve symptoms for some people. These measures do not repair a valve, but they can still be useful parts of a conservative care plan.
Sudden one-sided leg swelling, significant calf pain, warmth or redness, chest pain, shortness of breath, coughing blood, or fainting can indicate a blood clot or another urgent condition. Seek immediate medical care rather than waiting for a routine vein appointment.
Assessment starts with the cause
A vein assessment generally includes symptoms, medical history, examination, and a review of previous clotting or vascular problems. A duplex ultrasound uses sound waves to map the veins, evaluate the direction of blood flow, and identify reflux or obstruction.
The ultrasound helps determine whether a visible surface vein is being supplied by an incompetent saphenous vein and whether a catheter-based treatment is technically appropriate. Not every patient needs a procedure, and not every visible vein is treated the same way.
Ask which ultrasound finding explains the symptoms, what alternatives exist, and what improvement the proposed treatment is expected to provide.
How radiofrequency ablation works
Endovenous radiofrequency ablation, often shortened to RFA, closes a selected refluxing superficial vein from inside. Under ultrasound guidance, a clinician places a thin catheter into the vein through a small puncture. Local anesthetic is placed around the vein, and controlled radiofrequency energy heats short segments as the catheter is withdrawn.
After the vein closes, blood is redirected through other functioning veins. The treated vein gradually becomes fibrous tissue. Surface veins may fade over time, but some patients require separate treatment for remaining tributary or spider veins.
Map the vein
Duplex ultrasound confirms the anatomy, reflux pattern, and planned treatment segment.
Numb and protect the area
Local anesthetic is placed around the vein to improve comfort and protect nearby tissue.
Close the selected vein
The catheter delivers controlled energy while its position is monitored with ultrasound.
Walk and follow the care plan
Walking is commonly encouraged, with compression, activity, and follow-up instructions tailored to the patient.
Benefits, limitations, and risks
Published studies report durable vein closure and generally faster recovery after endovenous ablation than after traditional vein stripping in appropriately selected patients. Outcomes depend on vein anatomy, technique, follow-up duration, and how success is defined. No procedure guarantees that symptoms will resolve or that new varicose veins will never develop.
Potential complications include bruising, tenderness, inflammation of a surface vein, temporary numbness or altered sensation, skin burn, infection, bleeding, clot extension, deep vein thrombosis, pulmonary embolism, incomplete closure, or recurrence. Some complications are uncommon but serious. A clinician should explain personal risk before consent.
Other options may be appropriate
- Conservative treatment such as compression, walking, and symptom management.
- Endovenous laser ablation or another catheter-based technique.
- Ultrasound-guided foam sclerotherapy or surface sclerotherapy.
- Ambulatory phlebectomy for selected surface veins.
- Surgical ligation or stripping in selected circumstances.
- No procedure when symptoms, anatomy, or preferences do not support intervention.
Recovery and follow-up
Many patients walk shortly after treatment and return to light activities relatively quickly. Bruising, tightness, tenderness, or a pulling sensation along the treated vein may occur. Exact timelines vary, and published averages should not replace the instructions provided after a procedure.
Follow-up may include an ultrasound to confirm closure and check for clot-related complications. Contact the treating team for worsening pain, increasing swelling, spreading redness, drainage, fever, new numbness, or any symptom listed in the discharge instructions. Seek emergency care for chest pain, breathing difficulty, fainting, or other severe symptoms.
Common questions
Do I need a referral for an assessment?
A referral from a family doctor or nurse practitioner is commonly used for a surgical or specialist consultation in Ontario. Requirements can vary. The office can explain the current referral process, but individualized medical advice must come from an appropriate clinician.
Is radiofrequency ablation covered by OHIP?
Coverage depends on the assessment, indication, procedure, and current program rules. Some services may have an out-of-pocket cost or private-insurance coverage. Ask for a written explanation of expected costs before booking treatment.
Does every visible vein require RFA?
No. Small surface veins, veins without significant reflux, and symptoms caused by another condition may require a different approach or no procedure. Ultrasound and clinical assessment help distinguish these situations.
Will circulation be worse after a vein is closed?
The treatment is intended for a superficial vein that is allowing blood to flow in the wrong direction. Functioning veins continue to return blood toward the heart. The care team should explain the relevant anatomy and ultrasound findings for the individual patient.
Sources & further reading
- Proebstle TM, Alm BJ, Göckeritz O, et al. Five-year results from the prospective European multicentre cohort study on radiofrequency segmental thermal ablation for incompetent great saphenous veins. British Journal of Surgery. 2015;102(3):212–218.
- Lurie F, Creton D, Eklof B, et al. Prospective randomized study of endovenous radiofrequency obliteration versus ligation and stripping. Journal of Vascular Surgery. 2003;38(2):207–214.
- National Institute for Health and Care Excellence: Varicose veins—diagnosis and management
- Society for Vascular Surgery: Varicose veins patient information
Related information
Questions about arranging an assessment?
The office can explain referral requirements and the next administrative step. It cannot diagnose symptoms through the website.
Contact the office for guidance →Medical disclaimer: This page provides general educational information and is not medical advice, diagnosis, or a treatment recommendation. Individual results and risks vary. Discuss symptoms and treatment decisions with a qualified healthcare professional. In an emergency, call 911 or go to the nearest emergency department.