What is Endovenous laser treatment (EVLT)?
EVLT is a procedure performed in an office/clinic, requires no incisions and no hospital stay is required. After local anesthesia is administered, a laser fiber is inserted through a small needle hole in the skin into the vein that runs along the inner thigh. The laser is then slowly heated and the vein collapses around it. The collapsed vein soon shrinks and disappears. This technique rapidly treats the large varicose veins in the thigh and takes less than 30 mins to perform. Patients can resume all their normal activities soon after the procedure.
How does Endovenous laser ablation work?
The energy source from the laser irritates the vein walls, causes them to shrink and slowly disappear. The vein can no longer carry any blood through it. Because these veins are superficial, they are not important for transfer of blood to the heart.
Is loss of this vein a problem?
No. The saphenous vein which is destroyed is not healthy in the first place and of no use. Because the vein is engorged and thrombosed, removal has no affect on the body. The deep veins, however, are not touched by the laser as they continue to carry blood away from the legs.
What are the alternatives to this treatment?
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 anesthesia, leaves a scar and a few incisions. Sclerotherapy is not used to treat large varicose veins. Sclerotherapy for the saphenous vein has a high recurrence rate frequently requiring multiple treatments Other alternatives include ultrasound-guided mini sclerotherapy to destroy small branched veins and radio frequency electrosurgery.. Radiofrequency electrosurgery is similar to EVLT and is more of a physician choice and availability. So far the results are good and patients are satisfied.
How is EVLT performed?
The vein is identified just above the knee and the entire leg area is cleaned with an anti septic ointment. The entire procedure is performed with ultrasound visualization of the vein. A small amount of local anesthetic is applied and a needle is place in the vein. Through this vein is inserted a small laser probe. The probe is then 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 it to shrink and eventually leading to closure of the vein. The vein becomes fibrosed and does not carry any blood in it The procedure is painless and takes about 30-45 minutes. Once the vein is burnt, the probe is removed and a small dressing is applied. A compression bandage is applied and worn for 1 week. The patient is usually discharged home in an hour.
What is Recovery after EVLT?
The procedure leaves no scars, 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, all patients are encouraged to walk and resume their normal activities. A follow up appointment is made with the doctor in 1-2 weeks.
Is destroying the saphenous vein harmful?
No. Generally the saphenous vein is only destroyed when it is thick and thrombosed. The vein in this state is almost useless and non- functioning and 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.
Risks and Potential Complications
As with any invasive procedure, there are potential complications. These rare complications include:
- there may be mild numbness around the thigh area
- there may be 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 a common feature after the procedure. The bruising is mild and resolves in a week.
- Failure of the procedure does occur and may be related to the inability to place the probe in the vein. This does happen rarely. Other causes of failure are the inability of the laser to destroy the vein. The majority of technical failures are related to inexperience of the physician with the procedure.
Is the laser harmful to the eyes?
No. One is usually given a pair of special glasses to protect the eyes. There are no other harmful effects from the laser.
How successful is EVLT?
All data indicate that EVLT is a safe and effective procedure. The procedure does not involve any incisions and is relatively painless and has minimal complications.
What are disadvantages of EVLT?
The technique does not treat spider veins nor does it treat veins in the lower leg. Today, with an increased emphasis of preserving the veins for future use for either coronary artery bypass or some vascular procedure, EVLT completely destroys the vein and makes it unusable for future use.
How much does it cost?
EVLT when done in a symptomatic patient is a procedure which is reimbursed by most medial insurance and Medicare. Most insurance carriers require a trial of support or compression stockings and the need to take pain medication during the last six months. All Vein Centers will work with you and your insurance carrier through the predetermination process to determine medical necessity.
