Treatment method

Endovenous laser ablation - EVLA

More about Endovenous laser ablation - EVLA

Over the past 100 years, phlebologists have been performing surgical removal of varicose veins. This antiquated method was traumatic for patients and caused significant scaring. It also required long-term hospitalization and a lengthy period of recovery. More importantly, it was characterized by frequent relapses of the disease immediately following surgery. These unpleasant facts made patients and their acquaintances sceptical of this treatment option. Advances in technology have ushered in a modern era of phlebology, utilizing minimally invasive treatment methods. Instead of cutting veins they are glued, only non detectable punctures are left on the skin.

Laser treatment of varicose veins is performed without hospitalization, absence of scaring, does not require general anaesthesia, nor influence your normal daily routine. Lasers treatment makes it possible effectively ablate a varicose vein, while duplex ultrasound navigation provides for the removal just of the diseased part of the vein, reducing the probability of relapse.

Advantages of EVLA

  • This procedure is carried out under local anesthesia, and requires neither the use of general anesthesia nor hospitalization. A patient stays in the clinic for several hours, and afterward can immediately return to their usual lifestyle, work, as well as driving a car.
  • Simultaneous treatment of both legs is possible.
  • Disease relapse probability is extremely low, due to the use of duplex ultrasound during each treatment stage. Prior to treatment, a special marking is made — a kind of map — which makes it possible to precisely identify the cause, and location of all varicose veins, as well as the connections between them.
  • It does not leave any scaring All stages of treatment are performed by means of injections using extremely thin needles to puncture the skin.

Endovenouse laser ablation is the most significant revolution in phlebology over the past twenty years and has proven to be the least invasive and safest method of treatment worldwide. This minimally invasive outpatient surgery is performed in your doctor’s office. As the procedure does not require general anesthesia, incisions, and resulting need for sutures, but instead relies solely on small diameter injections. Patients can immediately return to their normal daily routines, aside from strenuous exercise after the procedure. These benefits make Endovenouse laser ablataion the preferred method of treatment for varicose vein removal.

How does EVLA work?

The varicose disease does not only affect veins which can be seen under the skin of legs. Although these veins are visually noticeable, they do not represent the main problem — venous reflux or valve insufficiency in major trunks veins is the main contributor of varicose disease: it is these that we will treat with a laser.

  • Modern German laser generators makes it possible to achieve the most effective conglutination of a varicose vein trunk.
  • Double laser radiation technology is used in the best disposable German laser waveguides making it possible for two beams to simultaneously affect a vascular wall, while radial directing of their radiation enables one to accurately direct the laser to the expanded vessel.
  • With the application of a laser, vein trunks are conglutinate — these vessels are the real cause of the disease — these include great saphenous veins, small saphenous veins or anterior accessory saphenous veins.
  • Laser energy impacts varicose vein walls causing their reduction and conglutination. Following treatment blood does not stagnate in varices, and henceforth does not lead to the intoxication of the surrounding tissues, and is instead redistributed to numerous healthy veins.
  • It is only possible to diagnose venous reflux or valve insufficiency in major trunks by means of ultrasonic duplex scanning. Damaged valves stop working in the varicose veins and no method is currently available to restored their functioning. The only option presently available to stop blood from moving in the wrong direction from the top downward is to close these veins and redirect blood to healthy vessels.
  • Varicose vein branches – those which can be seen under the skin — decrease over time following laser treatment since the source of their emergence is eliminated.

In advanced stages of the disease, these branches expand (varicose) making their reduction challenging. Therefore treatment should be complemented with miniphlebectomy or sclerotherapy immediately for several months after the laser treatment.

Additional information for patients
Well-proven efficiency of EVLA

International research backed with over 20 years of data on the use of this treatment method worldwide evidences a 98% efficiency of the technology and its application to remediate varicose veins.

How to prepare to EVLA

  • No premedication is required

  • Before treatment leg shaving is required

  • Patients are advised to wear comfortable clothes and footwear.

  • Patients should eat normal meals.

  • A pre-surgery blood tests package prescribed by their doctor is required. Blood tests must not be older than two weeks. Additional tests may be required as determined by the doctor.

How is EVLA performed

  • Pre-surgery marking of varicose veins is made, with the duplex ultrasound guidance — the resulting map displays the location of unhealthy veins, including those which are hidden, as well as their communication with healthy veins.

  • Depending on which vein is being treated — great saphenous vein or small saphenous vein  — the patient is instructed to lie down on their back, bending their leg slightly, alternatively they may be instructed to lie on their stomach.

  • Through a small puncture in the skin, a laser catheter is inserted into the lumen vein, most often in the area of the knee. The laser is guided using ultrasonography control to accurately position it in the varicose part of the vein.

  • Local anesthesia known as tumescent anesthesia is applied around the laser catheter again under ultrasonography control, via a small needle attached to a pump to properly dose the anesthesia, at this point of the procedure the patient may feel a slight discomfort.

  • Once the laser is activated the vein will gradually be conglutinated. At this stage the applied anesthesia causes the patient to feel nothing.

What to do after EVLK

  • Compression stockings need to be put worn.

  • Compression stockings need to be worn around the clock on the first day following the procedure then during the day for the following three to four days, and if desired up to 14 days — if the patient feels they require more support and comfort.

  • It is advised to walk between 20-30 minutes immediately after the procedure. Patients are permitted to drive themselves home or use public transport.

  • Patients are provided with their doctor’s direct phone number in case any questions arise.

  • During the post-surgery period patients are able to continue leading normal lives, aside from a brief pause in visiting their gym.

  • Formation of bruises within the post-surgery period is possible – this is a normal occurrence and these will disappear in a reasonable period.

  • Patients who need to travel by air within three to four weeks following surgery, may require additional prevention measures these will be prescribed by their doctor.

  • Occasionally follow up visits to the doctor are required within 1-3 days after surgery, especially if miniphlebectomy or sclerotherapy was performed in addition to EVLA.

  • Ultrasonography monitoring will be performed in the second week and a final ultrasonography is performed three months following surgery.

Possible complications

Assuming the responsibility for treatment, our moral imperative is to inform patients about possible complications which are however extremely rare:

  • Deep vein thrombosis.

  • Skin burns.

  • Nerve injury, which may lead to temporary loss of superficial sensitivity on a small area of the skin where the treatment was performed. This will disappear completely anywhere between several weeks or months. This complication occurs a fraction of the time as compared to open surgery.