Endovenous Laser Ablation

Endovenous laser ablation is a minimally invasive procedure performed in a physician’s office or clinic, for the treatment of varicose veins. A laser fiber is inserted through the skin and directly into the vein that is causing the bulgy, unattractive, and often painful varicose veins. The laser heats the lining within the vein, damaging it and causing it to collapse, shrink, and eventually disappear. This technique typically is used to treat the large varicose veins in the legs and takes less than 30 minutes to perform.

What are the benefits associated with endovenous laser ablation?

There are many reasons why patients may want to consider treating their veins using endovenous lasers. This treatment provides:

  • A reduced chance of developing stasis ulcers
  • Significant relief from discomfort such as aches, heaviness and pain
  • More efficient blood circulation
  • An improved body image and confidence in one’s appearance
  • A minimally invasive, quick and easy treatment option

How does endovenous laser ablation work?

The energy source from the laser irritates the vein walls, causes them to shrink and slowly disappear. Once this occurs, the veins can no longer carry blood through them. Because these veins are superficial, they are not necessary for the transfer of blood to the heart.

Is the loss of veins a problem?

Any vein that is destroyed is not healthy and actually can be detrimental to circulatory health. Because the vein is engorged and thrombosed, its removal has no adverse affect on the body. The healthy veins, however, are not touched by the laser and they continue to carry blood away from the legs in an efficient manner.

What are the alternatives to this treatment?

Because varicose veins are not considered life threatening, treating them is not absolutely required. However, when painful side effects or negative aesthetics motivate patients to seek treatment, there are a number of options.

  • Surgery has been the traditional treatment for varicose veins, and is moderately painful and has a slightly longer recovery period. Surgery requires the use of general anesthesia, leaves a scar and a few incision marks.
  • Sclerotherapy is another vascular treatment but is not used to treat large varicose veins. Sclerotherapy for the saphenous vein has a high recurrence rate frequently requiring multiple treatments.
  • Other potential treatment alternatives, such as ambulatory phlebectomy or bipolar radiofrequency, can be reviewed in consultation with your specialist.

How is endovenous laser ablation performed?

Throughout the procedure the patient should wear protective eye goggles to prevent any damage in the case of unplanned exposure to laser light. The skin over the treatment area will then be anesthetized with a topical anesthetic. The physician will proceed by inserting an 810 nm diode laser fiber into the faulty vein. The laser is identified with Ultrasound to verify its position and then the laser is slowly heated with low energy. The laser energy damages the vein walls causing them to shrink and eventually leading to closure of the vein. The vein becomes fibrosed and cannot carry any blood in it. The procedure is relatively painless and takes approximately 30 to 60 minutes. Once the vein is treated, the probe is removed and a small dressing is applied. A compression bandage is applied and worn for one week. The patient is usually discharged home in an hour.

What is recovery like after endovenous laser ablation?

The procedure leaves no scars, and is associated with minimal postoperative pain, a rapid recovery period and provides almost immediate relief from symptoms. Minor soreness and bruising can be treated with over the counter pain medication. After the procedure, patients are encouraged to walk and resume their normal activities. A follow up appointment is made with the doctor in the week after treatment, to evaluate the success and progress of the endovenous laser ablation.

Is destroying the saphenous vein harmful?

Of course, not all endovenous laser ablations require the saphenous vein be harmed. Generally the saphenous vein is only destroyed when it is thick and thrombosed. The vein in this state is extremely inefficient and can in fact inhibit blood flow and healthy circulation, so there is no harm in removing it. However, a normally functioning saphenous vein with no leaky valves should not be treated. A normal saphenous vein should always be preserved because it may be required in the future for open heart surgery.

What are the risks associated with endovenous laser ablation?

As with any medical procedure, there are potential complications. These rare complications include:

  • Mild numbness around the thigh area
  • A pulling sensation which may last a week
  • Phlebitis (redness and tenderness of the skin is quite common but is mild in nature and easily treated with over the counter pain medications. Most cases of phlebitis resolve in 3-7 days
  • Deep venous thrombosis. This is a very rare complications following endovenous laser ablation. The best way to prevent this rare complication is to wear compression bandage or compression stocking and to walk right after the procedure
  • Infection at an incision site is a rare occurrence and usually resolves on its own
  • Bruising is common after the procedure, but it is usually mild and resolves in a week
  • Other complications involving incorrect application or mistakes made in the execution of the procedure, which can usually be avoided by choosing a reputable, experienced physician

How successful is endovenous laser ablation?

All data indicate that endovenous laser ablation is a safe and effective procedure. The FDA has approved it for the treatment of varicose veins. Endovenous laser ablation is minimally invasive and enjoys a 98 percent success rate with a recurrence rate of seven percent after two years.

What are disadvantages of endovenous laser ablation?

The technique does not treat spider veins nor does it treat veins in the lower leg. In some cases, the saphenous veins may be compromised or destroyed during the procedure. With an increased emphasis in current medicine on preserving the veins for future use for either coronary artery bypass or another vascular procedure, this may be a concern for some patients.

How much does it cost?

If endovenous laser ablation is performed on a symptomatic patient, it will likely be covered by medical insurance and Medicare. In order to determine whether the procedure is medically necessary, insurance carriers may require a trial of support or compression stockings and the need to take pain medication during the last six months. Contact a local specialist for more information about the costs and insurance requirements associated with endovenous laser ablation.

Are there other names for endovenous laser ablation?

Endovenous laser ablation is also called endovenous laser therapy, ELT, EVLT, or laser varicose vein removal.

Below, Dr. Bruce Hoyle talks about endovenous ablation.

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