Endovenous Laser Treatments - 1

Endovenous Laser Treatment

What is endovenous laser treatment?

EVLT is a new method devised to treat varicose veins. It requires insertion of a laser fiber through the vein in the thigh and then heating the vein with the laser. The entire procedure is visualized by ultrasound. The laser probe takes a few minutes to burn the vein with minimal complications. The procedure is fast, effective and has little or no pain. In addition, this novel procedure is done as an outpatient, involves a small incision and results in rapid recovery.

How does EVLT procedure work?

The laser probe is inserted into the vein and when the probe is activated it heats up the vein. The heat energy generated by the laser probe causes the vein to collapse. Once the vein is collapsed, it is replaced by a thin fibrous scar. This is a permanent procedure and there is no chance of varicosities occurring in the area. Once the vein is burnt, it has no more capacity to carry any blood.

Are there any preparations required for EVLT?

There are no special preparations required for EVLT. During the procedure, your eyes will be protected against the laser beam with special dark glasses. If you are taking Aspirin or any blood thinners, you will need to discuss this with your doctor. In most cases, blood thinners should be stopped at least 1 week prior to the procedure.

How is EVLT performed?

EVLT is done as an outpatient procedure and can even be done during a lunch break. Ultrasound is required to observe the vein during the entire procedure. Your leg will be exposed from the groin to the lower thigh. A small amount of local anesthetic will be injected in your thigh and the entire leg will be cleaned with a sterile solution. Following this a small needle will be inserted in the vein at the thigh and through the vein, a small laser probe will be inserted all the way to the origin of the vein in the groin. When the probe is in the correct place, the laser is fired. The energy generated from the probe slowly causes the vein to collapse. The catheter is then slowly withdrawn while heating the entire vein.

After the procedure, a small dressing is applied to the thigh incision and a compression dressing is applied around the thigh.

How long does EVLT procedure take?

The average time for the procedure is about 30-45 minutes. One can expect to be at the doctor's office for about an hour.

Is EVLT painful?

There is some mild pain during the procedure. However, prior to the procedure, the doctor will inject some local anesthetic to numb the area. Once the procedure is over, there is minimal pain

When does one resume normal activities?

Most individuals return to work the following day. All individuals are encouraged to ambulate the first day. However, heavy exercise should be delayed for about a week.

When will I see the results of EVLT?

The vein takes about 2 weeks to shrivel up. The final cosmetic result is not seen for about 2 months.

What are side effects of the EVLT procedure?

Side effects are rare but may include:

- skin discoloration

- mild skin burns

- burning pain

- numbness

- bruising

- change in skin texture

The majority of these side effects disappear in 10-14 days.

What are the benefits of EVLT?

Compared to the usual varicose vein surgery, EVLT offers a number of benefits which include:

- it is relatively fast

- it is safe

- less extensive procedure

- there is minimal pain after the procedure

- there is less bruising

- there is only one very small incision

- there is little downtime, most individuals are able to return to work in 1-2 days

- there is no use of general anesthesia

Can EVLT be done during pregnancy?

No, it is best to wait until the pregnancy is over.

What are potential complications associated with the EVLT procedure?

Complications are rare but may include:

- vein perforation

- blood clot formation

- blood clot in lungs (pulmonary embolism)

- inflammation of the vein (phlebitis)

- blood collection (hematoma)

- infection

- paresthesia (numbness or tingling)

- Skin burn.

- Nerve damage

- bruising of the skin

- pain

- failure of the procedure to work

Is EVLT procedure suitable for everyone?

The EVLT procedure is only used to treat the large varicose veins. It is not suitable for spider veins. Normal veins should not be removed, because future open-heart surgery may require the use of these veins. EVLT is best for individuals with large varicose veins in the thigh area.

What are the limitations of EVLT procedure?

In those individuals with tortuous and small thrombosed varicose veins, the physician may not be able to pass the catheter through it. The procedure is only used to treat large varicose veins above the knee. Varicosities below the knee are not treated with EVLT.

How effective is EVLT procedure?

Most data indicate that EVLT is as good as surgery and most patients are satisfied with the results. There have been a few failures and these have mainly been due to inexperienced physicians and faulty technique.

What happens if the EVLT does not close my vein?

If endovenous laser treatment does not close a vein, you will need a second treatment. In some cases vein surgery is recommended.

How do I know that my vein has disappeared?

After 1-3 weeks, you will be seen by the physician who will perform an ultrasound to confirm that the vein has closed off.

What are other minimally invasive options for treating varicose veins?

Instead of using a laser, one can also use radiofrequency ablation as a probe. The entire procedure is the same except that radiofrequency ablation utilizes electrical heat instead of thermal heat. The treatment with radiofrequency ablation is only slightly longer by a few minutes.

IS EVLT used to treat spider veins?

No, spider veins are best treated with simple laser treatment or sclerotherapy