Endovenous laser ablation (EVLA), also known as Endovenous laser therapy (EVLT), is a minimally invasive procedure used to correct venous reflux disease, also called chronic venous insufficiency. Venous reflux disease is the underlying pathology that causes varicose veins, and tired, heavy, achy legs. The procedure is performed in the office under local anesthesia. Using ultrasound guidance, a laser fiber is inserted into the refluxing vein via a small nick in the skin. Laser energy is delivered to close the vein permanently. The procedure takes 30-45 minutes, and patients can drive after the procedure.
Once the procedure is complete, the blood is re-routed to healthy veins and leg circulation increases after the procedure. The leg is wrapped in an Ace bandage for 48 hours and a compression stocking is worn for 7 days. Walking is encouraged immediately following the procedure and normal activities can be resumed the same day or the following day. Full activities can be resumed in 7-10 days. Mild pain medications are sometimes necessary. EVLT is highly effective in the treatment of venous reflux, with a long-term success rate of 97%.
Endovenous Laser Therapy treats the following conditions:
- Chronic Venous Insufficiency.
- Varicose Veins.
- Swollen Legs.
Varicose Vein Treatment (Endovenous Ablation of Varicose Veins)
Varicose vein treatment, also known as endovenous ablation, uses radiofrequency or laser energy to cauterize and close varicose veins in the legs. It may be used for cosmetic purposes, but it is most commonly used to help ease varicose vein related symptoms such as aching, swelling, skin irritation, discoloration or inflammation. Endovenous ablation is safe, less invasive than conventional surgery, and leaves virtually no scars.
What are some common uses of the procedure?
Although this procedure may be used for cosmetic purposes, it is more commonly used to help ease symptoms related to varicose veins in the legs. Leg symptoms can include:
- Aching or throbbing pain.
- Leg heaviness/fatigue.
- Swelling.
- Skin irritation or sores (ulcers).
- Skin discoloration.
- Inflammation in the vein (phlebitis).
How should I prepare?
You should report to your doctor all medications that you are taking, including herbal supplements, and if you have any allergies, especially to local anesthetic medications, general anesthesia or to contrast materials containing iodine (sometimes referred to as “dye” or “x-ray dye”). Your physician may advise you to stop taking aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) or blood thinners for a specified period of time before your procedure.
You should wear comfortable, loose-fitting clothing. You will need to remove all clothing and jewelry in the area to be examined.
You should plan to have a relative or friend drive you home after your procedure.
You may be asked to wear a gown during the procedure.
How does the procedure work?
Ultrasound is used to visualize the varicose vein. A laser fiber or radiofrequency electrode is advanced to the desired location within the vein through an IV. Local anesthesia is injected to collapse the vein around the laser and act as insulation for the heat of the radiofrequency or laser energy. Laser or radiofrequency energy is then applied, heating the vessel and causing it to close. Following the procedure, the faulty vein will shrink and “scar down.”
How is the procedure performed?
Image-guided, minimally invasive procedures such as endovenous ablation are performed by a specially trained interventional vascular specialist.
This procedure is often done on an outpatient basis. However, some patients may require admission following the procedure. Please consult with your physician as to whether or not you will be admitted.
Your physician may use a topical anesthetic cream over the abnormal vein area before the procedure in order to reduce discomfort.
The leg being treated will be cleaned, sterilized and covered with a surgical drape.
Your physician will numb the area where the catheter will enter into the abnormal vein with a local anesthetic and use the ultrasound transducer or wand to study the vein and track its path.
A very small skin incision is made at the site.
Using ultrasound guidance, a catheter or vascular access sheath is inserted through the skin and positioned within the abnormal vein. The laser fiber or radiofrequency electrode is inserted through the catheter and the tip of the fiber or electrode is exposed by pulling the catheter back slightly.
Local anesthetic is injected around the abnormal vein with ultrasound guidance. Laser or radiofrequency energy is applied as the catheter is slowly withdrawn.
Pressure will be applied to prevent any bleeding and the opening in the skin is covered with a bandage. No sutures are needed.
This procedure is usually completed within an hour.
What are the benefits vs. risks?
Benefits
- No surgical incision is needed—only a small nick in the skin that does not have to be stitched.
- When compared with traditional vein stripping techniques, endovenous ablation is more effective, has fewer complications, and is associated with much less pain during recovery.
- Endovenous ablation is generally complication-free and safe.
- This procedure leaves virtually no scars because catheter placement requires skin openings of only a few millimeters, not large incisions.
- Endovenous ablation offers a less invasive alternative to standard surgery.
- Most of the veins treated are effectively invisible even to ultrasound 12 months after the procedure.
- Most patients report symptom relief and are able to return to normal daily activities immediately, with little or no pain.
Risks
- Any procedure where the skin is penetrated carries a risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in 1,000.
- Any procedure that involves placement of a catheter inside a blood vessel carries certain risks. These risks include damage to the blood vessel, bruising or bleeding at the puncture site, and infection. However, precaution is taken to mitigate these risks.
- Some post-procedure bruising and tenderness may occur, but may be eased by wearing a compression stocking.
- Some instances of thermal (heat) damage to nerves have been reported. This is rare and generally goes away in a short time.
- Thrombophlebitis (inflammation of the vein) is not uncommon and may cause pain and redness over the treated area, but generally responds well to nonsteroidal anti-inflammatory drugs (NSAIDs) as well as ice over the area.
- Blood clots that formed in the veins can travel to the lungs (pulmonary embolism); however, this is an extremely rare occurrence.
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