Radiofrequency perforator ablation is performed on perforator veins, short connections between your deep and superficial veins. Perforator veins can suffer the same sort of valve damage and retrograde blood flow (venous reflux) as other veins.perforating veins 250x300 1 Most patients with vein disease who experience skin changes, (that also may result in leg ulcers if left untreated) have reflux in perforator veins near their ulcers, as well as in the superficial or deep veins.

What are Perforator Veins?

Perforator veins serve as connections between the two networks of veins in the extremities, the superficial venous system and the deep venous system. Perforators connect the two parallel systems, and normally drain blood from the superficial veins to the deep veins as part of the process of returning oxygen-depleted blood to the heart.

Perforator veins have one-way valves designed to prevent backflow of blood down towards the superficial veins. When those valves no longer function properly and reflux occurs, the buildup of blood and pressure can cause not only the superficial veins but the perforators themselves to become incompetent. Perforator veins in the lower leg and ankle are particularly vulnerable to distention and incompetence, and the resultant circulatory problems create an increased likelihood of edema, skin discoloration, dermatitis and skin ulcers in the immediate area.

Your doctor may have recommended treatment of your perforator vein(s) because it is contributing to:

  • Venous leg ulcers
  • Pre-ulcerative skin changes
  • Persistent or recurrent varicose veins
  • Leg pain
  • Leg swelling
VNUSClosure Perforator Veins


Radiofrequency perforator ablation is an outpatient procedure, performed in the doctor’s office. Using ultrasound guidance, a fine needle is passed into the perforating vein through the skin. The radiofrequency current heats the inside of the perforator causing it to shrink down and remove the abnormal flow between the deep and varicose veins. Treatment itself takes approximately 10 minutes per perforating vein. Some patients have one perforator vein or multiple veins on the same leg that require treatment. You can expect to be in the office for at least an hour, because of the sterile preparation and set-up portion of the procedure.


RFA PerforatorThe procedure is performed with local anesthesia, but many patients elect to use a mild oral sedative (Valium), which is taken after checking in and completing all paperwork.  You will change into a gown or shorts. Depending on the vein to be treated, you will lay on your back or on your belly.  We do our best to make special accommodations (for example, if you cannot lie flat or cannot bend a knee very well) with body positioning and using pillows.  We will do our best to make you comfortable.  Then, we will give you the option of watching a movie on Netflix or listen to music. Once you are comfortable, you leg (s) will be prepped with cleansing solution for the sterile procedure. The doctor will perform an ultrasound to map the vein (s) to be treated.  Then, a numbing agent (lidocaine) will be injected into the skin. In the numb area of the skin, a tiny puncture is made to pass the radiofrequency catheter. Your doctor will then use a needle to administer additional local anesthetic around the vein.  This solution numbs the vein and insulates it from the surrounding tissue.  After the numbing solution is applied, the vein is painlessly treated with radiofrequency energy.  Once your vein has been treated, we will clean your leg and apply a compression stocking which you will wear for 72 hours continuously.   You will walk for 30 minutes prior to getting in your car.

What should I do after treatment?

You should walk 30 minutes twice daily after treatment.  This will alleviate discomfort and avoid pooling of blood in the legs.

What should I avoid after treatment?

For at least 7 days after treatment, you should avoid airline travel to minimize pooling of blood in the legs.  You should also avoid strenuous exercise (anything more than a brisk walk), heavy lifting, saunas or hot tubs, and leg massages for two weeks.  All of these dilate the superficial veins and interfere with their healing.

What are the possible adverse effects?  

It is normal to have aching in the treated veins.  This responds well to walking, ice packs, and anti-inflammatory medications such as ibuprofen (Advil®, Motrin®) and naproxen (Aleve®).

Expect some bruising over the injection sites, which fades over about two weeks.

Less common complications include blood clots within the deep veins or a temporary area of skin numbness over a tiny branch of a skin nerve that travels close to a vein.

The video below show the proceedure.  Other videos of our treatments are on our YouTube channel.   After care instructions can be found on our website in our patient library.


5 star reviews by actual patients

I had the best experience at La Jolla Vein Care. Dr.Bunke is an amazing doctor with the best bedside manners, she truly cares about her patients, she explained everything to me. My procedures where so easy I was impressed how painless and fast my appointments. Anna M was very helpful scheduling my treatments and checking on me to make sure all of my questions were answered. I am very pleased thank you !!! I truly recommend La Jolla Vein Care!

Henda S.

The office is exceptional, from front desk, to exam staff to the physicians. They have created a welcoming, relaxing environment, and take their time in examining and consulting with you to provide the best outcome. I highly recommend La Jolla Vein & Vascular for the assessment and treatment of your vein and vascular function.

Nancy F.

The staff kept you informed as to when you would be seen and the wait was not too long. Emily took care of my ultrasound and was very accommodating giving me an extra pillow and playing a video to watch. The office is very courteous and professional- Nadia answered our questions and offered us a bottle of water. I have been seeing Dr. Bunke, but now Dr. Lucas and will continue coming to La Jolla Vein Care! 

Rebecca D.

Beautiful facility! I walked in without an appointment and they took me right away! It was even the end of the day…I was so grateful…Every single person was soooo pleasant! Super impressed ❤️ 

Susan M.

The staff at La Jolla Vein Care Center are outstanding. They are friendly and helpful. Dr. Lucas and my ultrasound tech were both very thorough, kind and answered all of my questions. The new office was beautiful. I feel very confident that I am in good hands and that any up coming treatments will be successful. Thank for for making me feel so comfortable.

Ginger T.

Everyone here is so nice! Usually front desk medical personnel are so rude. The front desk ladies Alejandra, Anna, and I think her name is Liz, went above and beyond to take care of me and my insurance issues. The techs are great too! Rachel and a male technician assisted me…both of them implemented different techniques to make me feel more at ease during an uncomfortable and painful process. These procedures were rough…and I am grateful everyone was so sweet to me. Thanks again. 

Melissa B.

The staff members that I interacted with were all professional, conscientious and empathetic to my complaints and discomfort. I was taken into the ultrasound room a few minutes before my appointment time. I did not have a long wait before the ultrasonographer came and ran the machine. It was also a short wait before Dr. Steinburg came into the room with a warm, welcoming smile. We discussed my ultrasound and the things I was experiencing . I scheduled another appointment for next year and was offered a bottle of water upon leaving the office. All in all, I thought it was a very satisfactory appointment.

Renee P.

Dr De Young is personable and thorough in his explanations. Exceptional. 

James R.

I have been having leg treatments for several months now La Jolla Vein Care. Every time I go to an appointment; the staff is so friendly and takes such good care of me; always informative; not in a rush and always friendly (especially Alejandra & Anna to name a few). Of course Dr. Lucas is amazing. The treatments have changed my life. Overall this has been an incredible experience. 

Brigid Z.

La Jolla Vein care has the best staff ever. They are so nice, accommodating and professional!! Dr. Bunke is the best doctor that I ever seen. She is so friendly upfront and has the best bed side manner. I thank this office for letting me be their patient. 💜. Plus they are so careful with COVID which I really appreciate!!! 

Darlene H.

When I arrived for the first time, I could barely walk. My legs were red and swollen. After my treatments, I can now walk again. I’m so thankful to the doctor and his staff. They are caring, supporting and knowledgeable about my issues. Five Stars all the way!!!! 

Pamela M.

From my greeting at the front desk to the ultrasound and visit with the doctor, I received excellent care. It’s clear they care about their patients and all the staff couldn’t have been nicer or more helpful. I also appreciate how much time the doctor spent with me to explain the results and the next steps. I would definitely recommend this office to friends with vein issues. 

Anne S.

I am pleased to recommend La Jolla Vein & Vascular. I am in the process of receiving treatment there. The entire medical staff are super friendly, welcoming and very helpful. Everyone is courteous, including the physicians. I’ve had one doctor follow my case. He’s the one who always treats me at appointments and closely follows my health. I am very comfortable going there. Would go again if needed and encourage anyone who’s thinking of making an appointment to do so asap. You’ll see what a wonderful experience it is. It’s the people who make it so special!

Monica M.

We were early and didn’t have to wait at all. The tech that did my husband’s ultrasound, Monica, was very accommodating with my husband’s Parkinson’s. Doctor Lucas whom we hadn’t seen before, came to us instead of making my husband walk down to another office. She spent a lot of time getting caught up on Steve’s background issues/conditions. I was impressed by this medical group before, so I was surprised that the staff was even better this time around; I honestly didn’t think there was room for improvement! 

Linda N.

Highly recommend! Entire staff are warm& friendly, professional and accommodating. The doctor took the time to thoroughly explain everything and encouraged me to ask questions. I never felt rushed. Significantly better experience than the other 2 vein clinics I’ve been to on the east coast. I wish I could’ve just come here from the beginning. 


Make An Appointment

To make an appointment or to inquire about how we can help you understand your treatment options
La Jolla – Text us or Call 858-550-0330
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