Radiofrequency ablation (RFA) for varicose veins closes a faulty leg vein from the inside with heat delivered through a thin catheter. Most procedures take under an hour with local anaesthetic, and patients go home the same day. In a 2025 Japanese study that followed 350 treated legs for five years, 98.9% of great saphenous veins remained closed.
Drawing on official guidance and published research from Japan, the United States, the United Kingdom and Europe, this guide explains who is a candidate, how the procedure works, recovery time, how RFA compares with laser and surgery, and how side effects are managed. Varicose veins are a vascular condition, not cancer, and RFA is one of the image-guided procedures of interventional radiology (IVR).
Treatment status · RFA for varicose veins is a standard treatment in the United States and Europe, and in Japan it has been covered by national health insurance since 2014. All figures below come from studies of real patients and can vary with the hospital and the vein. This article is general information, not a treatment recommendation.
What is varicose vein RFA?
Leg veins contain valves that keep blood flowing up toward the heart. When the valves weaken, blood flows backward and pools, and veins under the skin become swollen and twisted. These are varicose veins. Heavy, swollen or aching legs are common, and over time the skin may darken or develop sores that heal slowly.
RFA closes the source vein that sends blood backward. This is usually the great saphenous vein on the inner thigh or the small saphenous vein at the back of the calf. The closed vein gradually shrinks into scar tissue, and blood returns through healthy deep veins.
RadiologyInfo, the patient site of the American College of Radiology and the Radiological Society of North America, describes it as a minimally invasive, image-guided treatment. A single small nick replaces an incision, so no stitches are needed and scarring is minimal. The heating principle is the same as RFA for tumors, but here the vein wall is sealed instead of a tumor. See our RFA overview and how radiofrequency ablation works.
Who is a candidate?
The UK National Institute for Health and Care Excellence (NICE) advises referral to a vascular service for symptomatic varicose veins, skin changes caused by venous disease such as pigmentation or eczema, hard and painful veins, or a leg ulcer that has not healed within two weeks. The same guideline says compression stockings should be used as treatment only when an intervention is unsuitable.
In its 2022 guideline, the European Society for Vascular Surgery (ESVS) strengthened its recommendation to use endovenous thermal ablation in preference to surgery or foam sclerotherapy for small saphenous vein reflux as well. Thermal ablation includes both RFA and laser.
Before the procedure, a Doppler ultrasound shows which veins are leaking. Very twisted veins can be hard to pass a catheter through, so another method may be chosen. Tell your doctor if you take blood thinners such as aspirin or anticoagulants, as you may be asked to pause them.
The procedure: under an hour with local anaesthetic
The steps below are based on RadiologyInfo and patient information from a UK NHS hospital.
| Step | What happens | What you feel |
|---|---|---|
| 1. Preparation | The vein is mapped with ultrasound, marked with a pen and the leg is cleaned | Nothing painful |
| 2. Catheter placement | The skin is numbed, a tiny nick is made and a catheter is guided into the vein under ultrasound | A brief pinprick and slight pressure |
| 3. Numbing along the vein | Local anaesthetic is injected along the vein under ultrasound | Often described as the most uncomfortable part |
| 4. Heat closure | The catheter tip is heated and slowly pulled back to seal the vein | Usually painless; some notice a burning smell |
| 5. Finishing | Pressure stops bleeding; a dressing and compression stocking are applied | No stitches |
Based on RadiologyInfo (ACR and RSNA) and Gloucestershire Hospitals NHS patient information.
The procedure usually takes under an hour and most patients go home the same day. Many stay awake with local anaesthetic only, while some hospitals use general anaesthesia. Bulging side branches can be removed through tiny cuts or treated with foam injections on the same day. In the Japanese five-year study, 2,000 units of heparin were given intravenously right after the procedure to prevent clots.
Results: five-year data from Japan and overseas comparisons
Dr Hitoshi Kusagawa of Matsusaka Ohta Clinic in Japan reported five-year results for 275 patients (350 legs) treated with RFA in Annals of Vascular Diseases in 2025. At five years, ultrasound showed 180 of 182 great saphenous veins (98.9%) and 41 of 43 small saphenous veins (95.3%) still closed. There were no cases of deep vein thrombosis or symptomatic pulmonary embolism, and the author concluded that the five-year results were generally good.
Overseas data point the same way. A 2024 meta-analysis of 29 studies and 7,303 patients found a one-year closure rate of 93.13% for RFA, similar to laser (94.18%). Pain after the procedure was lower with RFA, and one-year recurrence was 4.89% versus 6.82% with laser.
| Study | Patients | Key results |
|---|---|---|
| Japan, single centre, five years (Ann Vasc Dis 2025) | 275 patients, 350 legs | Five-year closure 98.9% great saphenous, 95.3% small saphenous; reoperation within five years 10.7% |
| Meta-analysis (J Vasc Surg Venous Lymphat Disord 2024) | 29 studies, 7,303 patients | One-year closure RFA 93.13% vs laser 94.18%; one-year recurrence RFA 4.89% vs laser 6.82% |
| Netherlands randomized trial (Br J Surg 2019) | 450 patients, three arms | One-year closure RFA (ClosureFast) 81.3% vs laser 75.0%; 98.0% would choose the same treatment again |
| Denmark randomized trial, five years (Int Angiol 2017) | Four treatments compared | Recanalization RFA 5.8% vs surgery 6.3%; retreatment RFA 17%, surgery 23.4%, foam 37.7% |
Study populations and definitions differ, so use these figures to see trends rather than for direct comparison. The Danish five-year figures are estimates based on patients examined at five years.
In the Dutch trial, symptom scores improved in all three groups at one year. In the Danish trial, RFA had the lowest rates of vein reopening and retreatment among the four methods.
RFA vs laser, surgery and foam
There are four main ways to treat the source vein. The right choice depends on the vein's size, how twisted it is, its depth under the skin and other health conditions.
| Method | How it works | What studies show |
|---|---|---|
| Radiofrequency ablation (RFA) | Heat from the catheter tip seals the vein wall | Closure similar to laser with less pain and bruising; covered by insurance in Japan since 2014 |
| Endovenous laser ablation (EVLA) | Laser heat from a thin fibre seals the vein | High closure rates, with less pain as wavelengths and fibres improved; covered in Japan since 2011 |
| Stripping (surgery) | The vein is tied off and pulled out | A long-established method; more early pain and time off than RFA in the Danish trial |
| Foam sclerotherapy | A medicine is foamed and injected to harden the vein | Simple with quick recovery; the highest retreatment rate (37.7%) in the Danish trial |
In the meta-analysis, burns and bruising within one month were 10.88% with RFA versus 14.54% with laser. Skin pigmentation was slightly more common with RFA (7.35% vs 4.06%). Some clinics also offer medical adhesive (glue) closure, which uses no heat, so ask which method suits you.
Recovery time and life after the procedure
You can walk straight after the procedure, and walking helps prevent clots. The timeline below follows UK NHS and RadiologyInfo guidance.
| When | What to do |
|---|---|
| Day of the procedure | Walk home, rest with the leg raised and have someone with you for 24 hours |
| First 48 hours | No driving, machinery or strenuous exercise; take at least 48 hours off work, sometimes a week |
| Around one week | Follow-up ultrasound to confirm the vein is closed |
| One to two weeks | Wear compression stockings or bandages as instructed |
| Two to three weeks | A pulling pain along the treated vein may remain; build up gentle exercise |
| Four weeks | Avoid flying (UK NHS hospital advice) |
Based on Gloucestershire Hospitals NHS (2025) and RadiologyInfo patient information. Advice varies between hospitals.
Patients travelling for treatment should plan flights carefully. The UK NHS hospital advises avoiding flying for four weeks, and RadiologyInfo advises avoiding air travel and long periods of sitting. Agree your return date with the treating hospital in advance. Resume driving when you can make an emergency stop without hesitation.
Side effects and how they are managed
Most side effects are mild and settle within a few weeks. Figures come from the meta-analysis, the Japanese five-year study and UK NHS guidance.
- Bruising and pulling pain: the most common. The vein may feel tight for two to three weeks; painkillers and walking help.
- Phlebitis: a firm, tender treated vein, seen in 3.86% in the meta-analysis. It often improves with anti-inflammatory painkillers and ice.
- Numbness: heat can reach a nearby nerve. It occurred in 3.63% in the meta-analysis and about 6.2% of legs in the Japanese study, mostly after full-length treatment of the great saphenous vein; 41% resolved completely within five years.
- Heat-induced thrombosis: a small clot at the end of the closed vein. It occurred in 5.9% in the Japanese study and all cleared within a month with anticoagulants.
- Deep vein thrombosis: about 1 in 100 according to the NHS leaflet. Walking often after treatment helps prevent it.
- Infection: RadiologyInfo reports infection needing antibiotics in fewer than 1 in 1,000 cases.
Contact a hospital immediately if your leg suddenly becomes very swollen and painful, or if you feel short of breath or have chest pain. For side effects of thermal ablation in general, see RFA side effects and complication rates.
What to check when treated in Japan or abroad
In Japan, laser ablation has been covered by insurance since 2011 and RFA since 2014, and endovenous thermal ablation is now widely used. In the Japanese five-year study, 10.7% of patients had a repeat procedure, most often because of perforating veins that connect the deep and surface veins. Regular ultrasound checks after treatment help find such changes early.
These questions are worth taking to your consultation.
- Which vein in my leg is leaking, and is RFA right for it?
- Will the bulging side branches be treated on the same day or later?
- How long should I wear compression stockings?
- When can I fly after the procedure?
- When and where will the follow-up ultrasound be done?
For other image-guided procedures see our IVR overview and uterine artery embolization guide; to prepare for a consultation see questions before an RFA consultation.
FAQ
Is radiofrequency ablation for varicose veins painful?
The injections of anaesthetic along the vein are usually the most uncomfortable part, and the heat closure itself is generally painless. In a 2024 meta-analysis, pain after RFA was lower than after laser.
How long is recovery after varicose vein RFA?
You can walk on the day of treatment. A UK NHS hospital advises no driving or strenuous exercise for at least 48 hours and compression stockings for one to two weeks. Most people return to work within two days to a week.
Can varicose veins come back after RFA?
In the Japanese five-year study, 98.9% of treated great saphenous veins stayed closed and 10.7% of patients had a repeat procedure within five years. New varicose veins can appear from other veins, so regular ultrasound checks help.
Is RFA or laser better?
The meta-analysis found similar closure rates. RFA caused less pain and bruising, while laser caused slightly less pigmentation. The choice depends on your veins and the hospital's experience.
This article summarizes official overseas sources and research as general information and is not medical advice. Please discuss treatment choices with a doctor who has examined you.
Sources (checked November 1, 2026)
- Kusagawa H. Clinical Results 5 Years after Radiofrequency Ablation of Saphenous Veins. Annals of Vascular Diseases. 2025;18(1):25-00097.
- Jiang W, et al. Endovenous radiofrequency ablation vs laser ablation in patients with lower extremity varicose veins: A meta-analysis. Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2024;12(5):101842.
- Hamann SAS, et al. Randomized clinical trial of endovenous laser ablation versus direct and indirect radiofrequency ablation for the treatment of great saphenous varicose veins. British Journal of Surgery. 2019;106(8):998-1004.
- Hirokawa M, et al. Comparison of 1470 nm Laser and Radial 2ring Fiber with 980 nm Laser and Bare-Tip Fiber in Endovenous Laser Ablation of Saphenous Varicose Veins. Annals of Vascular Diseases. 2015;8(4):282-289.
- Lawaetz M, et al. Comparison of endovenous ablation techniques, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Extended 5-year follow-up of a RCT. International Angiology. 2017.
- RadiologyInfo.org (ACR·RSNA). Vein Ablation.
- Gloucestershire Hospitals NHS Foundation Trust. Radiofrequency Ablation (RFA) for varicose vein treatment (patient information). 2025.
- NICE. Varicose veins: diagnosis and management (CG168).
- Vascular News. ESVS publishes 2022 guidelines on management of chronic venous disease of the lower limb (De Maeseneer MG, et al. European Journal of Vascular and Endovascular Surgery 2022).