Laser varicose vein treatment (EVLT)
Up until the last ten years, the only treatment option available for venous insufficiency was a major surgery called vein stripping, which was an invasive procedure with a long recovery that tended to fail after a few years. Over the past decade, a revolutionary new treatment has been developed, that is called Endovenous laser ablation (EVLT), is a minimally invasive procedure used to close down, or ablate, the incompetent superficial vein which is the underlying source of your symptoms and varicosities. This is accomplished through thermal ablation – or heat sealing – the vein shut using a very hot laser fiber tip which has passed into the vein through IV access lower in the leg. In order to allow the laser tip to heat up enough to seal the vein without causing damage to surrounding tissue, we will also be injecting a small amount of lidocaine all along the course of the vein to be treated. Ultrasound imaging is used before (to locate the target section of the vein), during (to monitor the therapy), and after (to ensure the treatment has been completed and other important deep veins have not been damaged). The procedure is commonly done in the office outpatient setting with minimal anesthesia and is generally very safe. The EVLT generally takes less than 30 minutes. In conjunction with EVLT, a minimally invasive surgical technique called ambulatory microphlebectomy is commonly used to complete treatment of varicose veins. After EVLT treats the source problem, the varicose veins which are bulging and dilated are then removed using a tiny nick. The blade used for this procedure is the same scalpel used for eye surgeries, and therefore is relatively painless after lidocaine administration and generally leaves no scars. The abnormal vein is then removed through this tiny incision or incisions using special tools. The procedure is done under local anesthesia and typically takes only a few minutes. Recovery is rapid, and most patients do not need to interrupt most regular activity after the procedure.
What are the benefits of EVLT?
– Minimally invasive – no surgical incision, no visible scars
– High success rate and low recurrence compared to surgery – success rate for vein ablation ranges from 93-97%
– Extremely safe with very low complication rate
– Minimal recovery time – patients are encouraged to walk and resume normal activities the same day!
– Covered by nearly all insurance carriers/healthcare plans
– Done in less than an hour
– Performed in a comfortable outpatient office setting
– No general anesthesia or sedation required for most patient
What should you do before an EVLT procedure?
– Do not shave the legs.
– Do not apply moisturizer on the day of treatment.
– Wear slacks or loose trousers and sandals or loose shoes to allow for the thickness of the bandages and compression garments.
What happens during an EVLT procedure?
– A sonographer will perform a limited ultrasound scan similar to the initial screening scan to familiarize us with the veins. The course of the vein will be marked.
– After you stand for 5 minutes, your varicosities will be marked with a marker using a device called a VeinLite so that their location is known after the EVLT procedure for the ambulatory microphlebectomy.
– You are awake with no need for anesthesia apart from one tiny injection to introduce the needle, similar to IV access. Some people request a small dose of anti-anxiety medication prior to the procedure.
– The EVLT tube, or catheter, is inserted into the vein under ultrasound control, and the tip is positioned at the top of the vein.
– Small amount of lidocaine are injected around the vein all along its course using multiple tiny needle sticks. The lidocaine around the vein, or tumescent, is used for pain relief, to further compress the vein, and finally to act as a layer of protection for surrounding adjacent structures such as nerves and skin.
– The laser tip is confirmed in place and the device is turned on. The laser is slowly retracted over 2-3 minutes, a process which the patient generally does not feel.
– Compression is then applied by a combination of bandages and compression garments.
– You may need to return later to complete treatment with ultrasound-guided sclerotherapy of the residual varicosities.