Endovenous Laser Ablation for Varicose Veins

Endovenous laser ablation (also called EVLT for endovenous laser treatment) is a minimally invasive procedure performed in a physician’s office or clinic, for the treatment of varicose veins. During an endovenous ablation procedures, your doctor inserts a laser fiber through the skin and directly into the varicose vein. The laser heats the lining within the vein, damaging it and causing it to collapse, shrink, and eventually disappear. Because these veins are superficial, they are not necessary for the transfer of blood to the heart. This technique typically is used to treat the large varicose veins in the legs and takes less than 30 minutes to perform.

About the procedure

Your doctor performs endovenous laser ablation in the office as follows. He/she will:

• Numb the skin over the treatment area with a topical anesthetic
• Insert an 810 nm diode laser fiber into the faulty vein
• Identify the laser with ultrasound to verify its position
• Slowly heat the laser so that the laser energy damages the vein walls causing them to shrink and eventually leading to closure of the vein

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.

Benefits and results of EVLT

There are many reasons patients 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

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.

Recovery 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.

Risks associated with EVLT

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

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.

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.

Alternatives to endovenous laser 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.

Cost of the procedure

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.

Below, Dr. Bruce Hoyle talks about endovenous ablation.