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Varicose vein treatments: What is endovenous thermal ablation therapy?

What is endovenous thermal ablation?If you’ve made the decision to move forward with treatment on your varicose veins, you may be a little nervous. Even though you know treatments at East Tennessee Vein Clinic are fast and minimally invasive, it can still be intimidating if you don’t know exactly what to expect. 

At East Tennessee Vein Clinic, you have more than one option when it comes to varicose vein treatment. We offer a number of different treatments, including endovenous thermal ablation, ambulatory phlebectomy, ultrasound guided sclerotherapy (including Varithena), cosmetic sclerotherapy and Venaseal. Each of these  is directed towards your particular need discovered by ultrasound at the time of your very first visit.

What can I expect during endovenous thermal ablation?

Endovenous thermal ablation tackles the hidden “root source” of varicose veins that are visible with a small catheter placed inside your failed saphenous vein. The saphenous vein is a large, shallow vein in the leg. 

As the catheter is withdrawn, the vein is sealed shut by heating the vein with either a laser (endovenous laser ablation i.e. EVLT) or a microwave (Closure-Fast i.e. RFA). The procedure usually takes about 10-14 minutes and is performed under local anesthetic. Nitrous oxide (laughing gas) is used to make you comfortable during the procedure. 

The procedure is performed in the office as an outpatient and you are able to both drive yourself to the appointment and home.  You resume normal activities immediately with a daily 20 minute walk for a week and an ultrasound recheck one week afterwards.  We ask patients to not lift over 40 lbs during that week but may resume full aerobic exercise.  We ask patients not to fly for 48 hours.

Unlike vein stripping, which is relatively infrequently performed in the United States, this procedure leaves the veins in place. The catheter heats and damages the vein walls, causing them to seal shut. The blood will reroute to other healthy veins in your leg (which it had already been following before as blood could not move up the leg through failed veins). 

Who is endovenous thermal ablation not good for?

Before scheduling any form of treatment, our doctors will evaluate which procedure is best for you. We will perform a diagnostic ultrasound, which will let also us know whether there are any clots or deep vein issues that need to be addressed first. We will also determine what other treatment you may need to completely resolve your varicose veins.  

If your veins are too small or have scarring making veins inaccessible to endovenous thermal ablation we may recommend an alternative procedure.

Endovenous thermal ablation uses heat to seal hidden ridden sources of visible varicose veins, but afterwards many patients will still have very large visible varicosities on their legs which remain to be addressed.  This is because while it is imperative the hidden source of veins be treated first (think from the roots up) there are other veins where a catheter cannot reach or address that is addressed with additional procedures.  These branch veins may be too twisted for a catheter such as is treated with thermal ablation or may lie near other structures such as nerves which we do not wish to treat with heat nearby.

What can I expect after EVLT?

After your procedure, we recommend that you walk immediately afterward. You’ll need to wear compression stockings for a week or possibly more, but normal activity can be resumed immediately. The stockings should be worn overnight and during the day, although you may remove them to shower. 

You will experience some swelling and tenderness along the length of the vein after the procedure. We recommend taking Advil or Tylenol as needed for a week following treatment. 

Our procedures are all outpatient. You’re welcome to drive yourself to and from your appointment. We do recommend that you avoid strenuous activities for 1 week with no heavy lifting over 40 lbs for a week. 

We also recommend daily walks for about 20 minutes. 

We recommend the following precautions after EVLT:

  • If you have any significant swelling, redness or drainage, contact our office at 865-686-0507.
  • If you develop any chest pain or shortness of breath, seek immediate medical attention and contact of our office.
  • Avoid strenuous activity for seven days (such as lifting over 40 lbs.)
  • Replace strenuous exercise routines with aerobic exercises such as walking, running or jogging for 7 days
  • Elevate your legs for 15-20 minutes per day at the end of the day to promote rapid healing



If you would like to learn more about varicose vein treatment options, schedule a free consultation today! Varicose veins are genetic and progressive, but our minimally invasive procedures can relieve your symptoms fast.

“The service was great. Will be back – Thanks for your kindness.”

- D.J., Gatlinburg, TN