Radiofrequency ablation for varicose veins (Radiofrequency ablation (RFA) of varicose veins)
A keyhole treatment that uses heat from a thin tube inside a faulty leg vein to seal it shut, so blood is diverted to healthier veins.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- RFA seals a faulty leg vein from the inside using heat, so blood reroutes through healthier veins.
- It treats the underlying vein but may not clear every visible bulge — some people need extra treatment to surface veins.
- Recovery is usually quick: most people walk out the same day and return to normal activities within a day or two.
- Choose a vascular specialist who scans your legs with ultrasound first and is honest about whether treatment is needed at all.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your surgeon will give you advice for your situation.
Treats the underlying faulty vein, not just the visible bulges
There is no significant vein reflux on ultrasound, so treating a vein is unlikely to help symptoms.
You walk soon after the procedure and go home. Keep moving little and often rather than sitting still for long periods.
A duplex ultrasound follow-up to confirm the vein has sealed and look for early clot problems.
You walk soon after the procedure and go home. Keep moving little and often rather than sitting still for long...
Wear your compression stocking as advised. Mild bruising, tenderness and tightness are normal. Most people return...
Bruising fades and the treated vein may feel like a firm cord under the skin. You can usually return to exercise...
Visible veins and aching continue to settle. A follow-up scan or review may be arranged to check the vein has...
What is radiofrequency ablation of varicose veins?
Radiofrequency ablation (RFA) is a keyhole treatment for varicose veins. A thin tube (catheter) is passed up the faulty vein through a tiny entry point, usually near the knee or ankle. The tip heats the vein wall so the vein seals closed. Once it is sealed, your body gradually absorbs it and blood reroutes through healthy deeper veins.
Varicose veins happen when small valves inside leg veins stop working, so blood pools instead of flowing back to the heart. This can cause aching, heaviness, swelling, itching, skin changes or, over time, leg ulcers. RFA treats the underlying faulty vein (most often the great saphenous vein) rather than just the bulging veins you can see.
RFA is one of two main "endothermal" (heat-based) treatments; the other is endovenous laser ablation. UK guidance (NICE) recommends a heat treatment like RFA as the first choice for suitable people, because it works well and recovery is usually quick.
It is important to know that treating the main faulty vein does not always remove every visible bulge in one go. Some people need extra treatment, such as phlebectomy or foam sclerotherapy, to the smaller surface veins.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Heat ablation (RFA) vs foam sclerotherapy vs surgery
| Feature | RFA (heat) | Foam injection | Surgery (stripping) |
|---|---|---|---|
| Anaesthetic | Local | Local | Often general |
| Recovery | Usually quick | Usually quick | Usually 1–2 weeks |
| NICE order | First choice | If heat unsuitable | If both unsuitable |
| Repeat treatment | Sometimes needed | More often needed | Less often needed |
NICE recommends trying these in order of suitability. The best option depends on your vein anatomy, which a duplex ultrasound scan helps decide.
Preparing for your procedure
- Have a duplex ultrasound scan of your leg veins first — this maps which veins are faulty and confirms whether treatment is appropriate.
- Tell the team about any history of blood clots (DVT), clotting disorders, or a strong family history of clots.
- List all your medicines and supplements, including blood thinners and the contraceptive pill or HRT, as some affect clot risk.
- Mention any problems with the arteries in your legs, skin infection, or reduced mobility.
- Wear or bring loose clothing; you will usually be asked to bring or buy compression stockings to wear afterwards.
- Arrange to walk afterwards — you will be encouraged to be up and moving, not resting in bed.
- Ask whether you need someone to drive you home, especially if sedation is used.
What happens
The procedure is usually done awake under local anaesthetic, sometimes with light sedation. Using ultrasound to guide the way, the specialist makes a tiny entry point and threads a thin catheter up the faulty vein.
Local anaesthetic fluid is injected along the vein (called tumescent anaesthesia). As well as numbing the area, this fluid surrounds and protects nearby tissues and nerves from the heat. The catheter then heats the vein wall in short sections as it is slowly withdrawn, sealing the vein closed.
If you also have bulging surface veins, the specialist may remove them through tiny nicks (phlebectomy) or inject them (foam sclerotherapy) at the same time. The entry point is small and usually does not need stitches. A compression stocking or bandage is applied and you are encouraged to walk before going home, usually the same day.
Is this procedure right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- There is no significant vein reflux on ultrasound, so treating a vein is unlikely to help symptoms.
- You have a current deep vein clot or the deep veins are blocked, so superficial veins may be helping blood return.
- You have significant arterial disease in the legs, which affects compression and healing.
- The faulty vein is very close to the skin or in an awkward position, raising the risk of skin burn or nerve injury — another method may be safer.
- Active skin infection at the planned entry site.
Delay or rearrange if…
- You have an active leg or skin infection.
- You are pregnant — varicose veins often improve after birth, so treatment is usually deferred.
- You have a recent blood clot or are acutely unwell.
- Anticoagulation or a clotting problem needs review and a clear plan first.
- You have not yet had a duplex ultrasound scan to map the veins.
Alternatives to discuss
- Compression stockings and lifestyle measures (weight, activity, leg elevation), especially for mild symptoms.
- Foam sclerotherapy if heat ablation is unsuitable.
- Surgery (ligation and stripping) if neither heat ablation nor foam is suitable.
- Non-thermal techniques such as mechanochemical ablation or cyanoacrylate glue closure where offered.
- Watchful waiting if symptoms are mild and the legs are otherwise healthy.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Treats the underlying faulty vein, not just the visible bulges
- Can ease aching, heaviness, swelling, itching and restless legs caused by varicose veins
- Usually done under local anaesthetic, so no general anaesthetic is needed for most people
- Recovery is usually quick, with most people back to normal activities within a day or two
- May help skin changes settle and can reduce the risk of varicose-vein leg ulcers
- High rate of successfully sealing the treated vein
Risks & complications
- Bruising, tenderness or tightness along the treated vein for a week or two
- A firm, cord-like feeling under the skin as the sealed vein settles
- Temporary skin discolouration or staining over the treated vein
- Some visible veins remaining that may need further treatment
- Patches of numbness or tingling near the treated vein from minor nerve irritation, usually temporary
- Inflammation in the treated vein (thrombophlebitis) causing redness and soreness
- Small skin burns or blisters (uncommon with modern tumescent technique)
- The vein not sealing fully, needing repeat treatment
- Deep vein thrombosis (a clot in a deep leg vein)
- Clot extending from the treated vein towards a deep vein (endovenous heat-induced thrombosis)
- Pulmonary embolism (a clot travelling to the lungs) — very rare
- Skin infection at the entry point
The most important risk to understand is a blood clot in the deep veins, which is uncommon but is why you are kept moving and may be given compression. Tell your specialist about any previous clots, clotting problems, or hormone medicines. Some numbness near the treated vein is fairly common and usually fades, but ask how likely it is for your particular vein.
Published figures to discuss
Reported rates vary with the vein treated, the technique and how complications are defined and followed up. Vein sealing (occlusion) rates are high, but recurrence of varicose veins over the years is genuinely common. Serious clot complications are uncommon, but matter, which is why prevention and clear warning-sign advice are essential. Exact figures should be discussed for your individual situation.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Treated vein successfully sealed (short term) | Around 99% on early follow-up scans in published series | Success is usually confirmed by duplex ultrasound a few weeks later; sealing remains high at several years in many studies. | Endovenous radiofrequency ablation for varicose veins (review) — PMCpmc.ncbi.nlm.nih.govPublished figure |
| Recurrence of varicose veins over time | Reported across a wide range, roughly under 1 in 10 up to about a third | Varies greatly by follow-up length and definition; reflects the ongoing tendency to varicose veins rather than failure of the seal. | Endovenous radiofrequency ablation for varicose veins (review) — PMCpmc.ncbi.nlm.nih.govPublished figure |
| Deep vein thrombosis (DVT) | Low — commonly reported around 1–2% or less in series | Movement and, where used, compression and risk assessment reduce this; previous clots raise the risk. | Endovenous radiofrequency ablation for varicose veins (review) — PMCpmc.ncbi.nlm.nih.govPublished figure |
| Nerve irritation / numbness near the vein | Uncommon and usually temporary; around 0.3% reported as persistent nerve injury in some pooled data | More likely for veins lying close to nerves; tumescent anaesthesia helps protect them. | Endovenous radiofrequency ablation for varicose veins (review) — PMCpmc.ncbi.nlm.nih.govPublished figure |
| Skin burn | Low — around 0.3% in pooled cohort data | Modern tumescent technique makes this uncommon. | Endovenous radiofrequency ablation for varicose veins (review) — PMCpmc.ncbi.nlm.nih.govPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Recovery from RFA is usually quick. Most people walk out the same day, are encouraged to be active straight away, and return to normal life within a day or two — but bruising and a tight, cord-like feeling can last a couple of weeks.
- Bruising and tenderness along the inner thigh or calf
- A tight, pulling or cord-like feeling over the treated vein
- Mild swelling of the leg or ankle in the first days
- Brownish skin staining over the treated vein that usually fades over months
- Some visible veins still present, which may need a further procedure
Aftercare
- Walk regularly and avoid long periods sitting or standing still in the first couple of weeks.
- Wear your compression stocking for as long as the team advises (often around a week, but advice varies).
- Take simple pain relief such as paracetamol if needed; check before using anti-inflammatory tablets.
- Keep the small entry point clean and dry as instructed.
- Avoid long-haul flights or very long car journeys in the early period unless your specialist says it is safe.
- Go to any follow-up scan, which checks the vein has sealed and looks for early clot problems.
- Know who to contact if you notice calf pain, swelling or breathlessness.
- Duplex ultrasound scan done before treatment
- Compression stockings bought or supplied
- Plan to walk and stay mobile afterwards
- Simple pain relief at home
- Loose, comfortable clothing and footwear
- Lift home arranged if sedation is used
- Clinic contact number for problems saved
Scars and how they heal
RFA uses a tiny entry point that usually heals to a small, barely visible mark and does not normally need stitches. If phlebectomy is done at the same time, there will be several tiny nicks that fade over months. Brownish staining can appear over the treated vein and usually settles, though faint discolouration occasionally lingers.
⚠ Get urgent help if…
- Painful, swollen or hot calf or thigh — this could be a deep vein clot
- Sudden breathlessness or chest pain — call 999, as this could be a clot on the lung
- Spreading redness, increasing pain, pus or fever (signs of infection)
- A skin burn or blister that is worsening
- New severe leg pain or the leg becoming pale or cold
- Numbness or weakness that is getting worse rather than better
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your surgeon gives you.
Results & realistic expectations
A good result means the faulty vein is sealed, blood reroutes through healthy veins, and symptoms such as aching, heaviness and swelling improve. The treated vein seals immediately in the great majority of cases and a follow-up scan can confirm this.
Closing the main vein does not always remove every visible bulge. Surface veins may need phlebectomy or foam sclerotherapy, and thread veins are a separate cosmetic issue. New varicose veins can also develop over the years, because RFA treats today's faulty veins but does not stop the underlying tendency.
Most treated veins stay sealed long term, and studies report high closure rates several years on. However, recurrence of varicose veins is common over time — reported across studies in a wide range, roughly from under 1 in 10 up to around a third of people, depending on follow-up length and how recurrence is defined. New veins can appear because the tendency to varicose veins remains. Some people choose a further procedure later if symptoms return.
Related tests, treatments or support
RFA is often combined with phlebectomy (removing surface bulges through tiny nicks) or foam sclerotherapy (injecting smaller veins) to improve the appearance and treat tributaries. Thread veins, if present, are a separate cosmetic concern usually treated later and not normally on the NHS.
Follow-up & long-term care
Many clinics arrange a follow-up duplex ultrasound scan a few weeks after treatment to confirm the vein has sealed and to check for early clot problems. This review is also when any remaining surface veins are assessed for further treatment. Report calf pain, swelling or breathlessness without waiting for the appointment.
- Stay active and keep to a healthy weight to reduce pressure on leg veins
- Use compression stockings if advised for symptoms or to reduce swelling
- Have remaining surface or thread veins reviewed if they bother you
- Seek review if aching, swelling or new bulging veins return
Repeat, follow-on and what comes next
- Some people need a second session for surface veins (phlebectomy or foam) after the main vein is sealed.
- If the vein does not fully seal, repeat ablation or an alternative treatment may be offered.
- New varicose veins can appear over the years and may prompt further treatment.
- A small clot extending towards the deep veins (EHIT) occasionally needs monitoring or short-term blood-thinning.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A duplex ultrasound follow-up to confirm the vein has sealed and look for early clot problems.
- Clear written instructions on staying mobile, using compression and recognising clot warning signs.
- A named contact and out-of-hours route if calf pain, swelling or breathlessness occurs.
- An honest plan for any remaining surface or thread veins, including whether they are NHS-funded.
- Review of clot risk factors such as hormone medicines and previous clots.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether one or both legs are treated, and how many veins are involved
- Whether phlebectomy or foam sclerotherapy is added to treat surface veins
- The duplex ultrasound scan and who performs and reports it
- Use of sedation as well as local anaesthetic
- The specialist's fee and the facility or day-case unit fee
- Follow-up scans and any further sessions needed
- Compression stockings and aftercare
- The specialist's fee and the facility/day-case fee
- The cost of the duplex ultrasound scan and its reporting
- Whether phlebectomy or foam sclerotherapy is included or charged separately
- Sedation costs if used
- Follow-up scans and review appointments
- What happens, and what it costs, if further treatment or a repeat procedure is needed
- Compression stockings and the cancellation policy
On the NHS? Treatment for symptomatic varicose veins, including radiofrequency ablation, is available on the NHS when clinical criteria are met; people may choose private care for speed or convenience, but cosmetic-only treatment is not usually NHS-funded.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Being offered treatment without a duplex ultrasound scan first, or for veins with no real reflux.
- Not being told that surface bulges or thread veins may need separate treatment.
- No clear discussion of clot risk or the warning signs of DVT and pulmonary embolism.
- Being promised the veins will never come back.
- No written aftercare plan or out-of-hours contact route.
Marketing red flags
- "Walk-in walk-out, no risk" language that ignores clot and nerve risks.
- Promises of permanent results or that varicose veins will never recur.
- Pressure to treat cosmetically minor veins, or both legs, without clear symptoms or ultrasound findings.
- Before-and-after photos with no mention that further sessions are often needed.
- No mention of duplex ultrasound assessment in the pathway.
Choosing a specialist safely
- Check the surgeon is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the surgeon who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good surgeon will welcome every one of these.
- Have my leg veins been scanned with duplex ultrasound, and which vein is faulty?
- Do my symptoms actually need treatment, or could compression or watchful waiting be reasonable?
- Will I also need phlebectomy or foam sclerotherapy for the surface veins?
- What is my personal risk of a blood clot, and what will be done to reduce it?
- How likely am I to need repeat treatment, and what would that involve?
- Will I have a follow-up scan to check the vein has sealed?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the surgeon who carries out my procedure, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this procedure not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Is radiofrequency ablation available on the NHS?
Does it hurt?
How soon can I go back to work and exercise?
Will all my visible veins disappear?
Can the varicose veins come back?
What is the difference between RFA and laser (EVLA)?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NICE CG168 — Varicose veins: diagnosis and management NHS — Varicose veins: treatment Circulation Foundation (Vascular Society) — Varicose veins & leg ulcers Endovenous radiofrequency ablation for varicose veins (review) — PMC Radiofrequency ablation for varicose veins: evidence-based analysis — PMC Varicose vein treatment: radiofrequency ablation — StatPearls (NCBI)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
Related guides: Foam sclerotherapy for varicose veins · Microsclerotherapy for thread veins · Phlebectomy (vein removal) · Angioplasty and stenting · Endovascular aneurysm repair (EVAR)