Endovenous laser ablation used to treat the underlying cause of varicose veins

Endovenous laser ablation (EVLA, sometimes referred to as EVLT) remains the gold standard treatment for varicose veins. It is also the recommended treatment for this condition as per the National Institute of Health and Care Excellence’s (NICE).

Endovenous laser ablation can be used to treat the underlying conditions to varicose veins

Image Credit: Veincentre

EVLA treats the underlying condition that leads to the appearance of varicose veins, restoring healthy blood flow to the legs. This technique effectively addresses both the symptoms associated with varicose veins and their cosmetic appearance.

This straightforward walk-in, walk-out procedure is performed under local anesthetic on an outpatient basis, typically taking less than 1 or 2 hours, depending on the number of veins being treated.

The majority of patients undergoing this procedure have described the EVLA procedure and its associated recovery period as uncomfortable but not painful.

Development and history of EVLA

EVLA was developed in the United States more than 20 years ago. Since that time, the medical community has observed and published excellent long-term results in terms of its safety and effectiveness.

The technique has revolutionized the treatment of varicose veins, meaning that there is no realistic need to offer surgical stripping under general anesthetic as the first-line treatment for varicose veins.

The EVLA procedure

A laser fiber is inserted into the vein to be destroyed. This is done using ultrasound to guide the laser. Heat is applied, and the laser fiber is slowly and carefully moved along the length of the vein.

This process essentially kills the target vein, with the dead vein slowly absorbed by the body. After this process is completed, a healthy blood flood is restored to the legs.

The EVLA procedure involves a number of key stages:

Pre-procedure

An ultrasound scan is performed prior to the EVLA procedure in order to identify the problematic, poorly functioning veins that are the underlying causes of the patient’s varicose veins.

Before the procedure begins, the patient is given comprehensive information on treatment options, including potential complications and success rates. This is normally done during the initial consultation.

It is important to weigh up the benefits versus the risks with any medical treatment, and patients are advised to consider these fully.

It is also vital that patients understand and are happy with the proposed treatment before agreeing to go ahead and sign the necessary documentation.

The procedure takes place in a small treatment room, with the music of the patient’s choice played if this helps them to feel more comfortable. The patient is also introduced to the nurse, who will be at their side throughout the procedure, helping to support them through the process.

The procedure

As an ultrasound scanner is used to guide the procedure, the specialist has a live view of the patient’s veins throughout.

A small bleb of local anesthetic is injected before a needle is inserted into the target vein that contains the faulty valves. A thin guidewire is carefully inserted through the needle and into the vein.

Once this wire has reached the appropriate position, a sheath of thin plastic tubing is inserted over the wire and fed along the vein. Next, the guidewire is removed, and the laser fiber is fed through the catheter into the vein.

With the laser fiber in position, a significant amount of local anesthetic is administered along the full length of the vein using a series of injections along the leg. This extra local anesthetic will numb the leg and protect the tissues surrounding the target vein from damage.

With the leg completely anesthetized, the laser is activated, delivering powerful laser light directly to the vein and heating up the tissues in the wall of the vein to a level sufficient to destroy them.

Once this has been done, the laser fiber is slowly and gently withdrawn along the vein, heating up the vein wall and destroying this in situ as it passes through. The process takes between 5 to 10 minutes per vein.

The local anesthetic ensures that patients are not in any major discomfort as the vein is lasered, though there may be some minor aching, and patients may notice odd smells and tastes.

This process is repeated on every vein that has been identified as causing the patient’s varicose veins.

A small number of patients - less than 5% - have reported that they found the local anesthetic injections and lasering painful, though most find the sensations to be more strange and uncomfortable. There does not seem to be a discernible pattern around which patients will find the experience painful, however.

After the vein has been heated and destroyed, it can take a number of weeks for the body to naturally absorb the dead tissue left behind.

Once the vein has been destroyed, the blood that previously flowed through it is diverted to healthy, normal functioning veins. The impact of this diversion is minimal since the destroyed vein was not functioning properly to begin with.

Post-procedure

Following the procedure, a nurse will apply compression stockings to the treated leg, outlining the stockings’ application and any post-treatment symptoms to be aware of. The patient is also asked to take a brief 10-minute walk following the appointment.

Once this has been done, the patient is able to go home. It is not possible to drive on the day of treatment, but it is possible the day after. It is important to note that patients should not fly long haul (over 4 hours) for a total of 4 weeks post-procedure.

Recovery

After treatment, it is necessary to wear a compression stocking for a week. Patients may experience some tautness as the vein shrinks over the coming weeks, and there will likely be bruising of the leg. This bruising is mild for most patients, but it can be quite severe. In either case, this is a normal part of the healing process.

Most patients experience little or no pain and are able to resume their day-to-day activities straight away, provided the support stocking is worn, and these do not include strenuous activities like swimming, weightlifting or horse riding. It is important to follow the consultant’s advice in all cases.

A minority of patients will experience severe pain, often requiring time off work. If this does occur, it is typically around 5 -7 days post-treatment rather than immediately. The is the period when treated veins begin to be absorbed by the body - a process that patients tend to describe as a tightening sensation.

Symptoms associated with varicose veins, such as aching, throbbing or itching, will start to alleviate rapidly following the EVLA treatment, with patients typically finding that their symptoms have fully resolved before their follow-up appointment.

EVLA follow-up

It is strongly advised that patients attend a follow-up appointment around 6 to 8 weeks after EVLA treatment. Most patients will require some type of treatment at follow-up, but this appointment is primarily to verify that EVLA treatment has successfully addressed the underlying vein problems.

Varicose veins may still be present at the follow-up stage, though these are generally much smaller. The varicose veins will rarely be gone entirely after a single treatment and may still be their original size.

This does not indicate the treatment has failed, however. EVLA fixes the underlying problem, but many patients require foam sclerotherapy or avulsions/phlebectomies in order to treat the actual varicosities.

About Veincentre

Veincentre are the UK’s leading varicose veins specialists using Gold Standard, minimally invasive techniques, with 15 clinics nationwide.

At Veincentre, we provide the most effective, proven treatment and the highest quality of care that is accessible to everyone. We treat the cause, not just the symptoms! All our treatments are minimally invasive – walk-in, walk-out, require no general anaesthetic, no surgery and no time off work.

The most important aspect of care for any condition is the ability and attitude of the team of doctors and nurses looking after you. We have headhunted some of the most experienced and respected vein specialists in the UK. By choosing Veincentre, you can be assured that discomfort will be minimized, outcomes will be optimized, and you will be looked after by a team who really care for you

From your initial point of contact you will be communicating with our patient advisers, who only deal with patients who suffer from varicose veins so are all highly experienced and can confidently answer all of your queries or provide any advice.

Start your journey to healthy veins and happy legs…


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Last updated: Dec 21, 2021 at 11:15 AM

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