Endovenous Laser Ablation (EVLA) Treatment involves a fibre-optic catheter being inserted into the varicose vein and using laser-generated heat to shrink and ultimately close the vein.
Endovenous ablation technology has become more widely used over the last 5 years as it is a much more comfortable procedure for the patient than older surgical methods.
EVLA treatment makes use of haemoglobin-specific lasersthat use 810, 940 and 980nm frequencies and new generation 1320 and 1470nm lasers specific for endothelin water (a type of peptide) in the blood. These new generation lasers have been shown in clinical trials to be more effective and to have reduced side effects (bruising, loss of sensitivity, burning, need for painkillers etc.) At estethica, we perform EVLA treatment with 1470nm lasers and radiofrequency ablation.
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First of all, your veins are mapped using Doppler Ultrasound to help your doctor accurately assess your condition. Then, the laser catheter is inserted into the vein while being monitored with the Doppler Ultrasound until it reaches a position 2cm short of the femoral vein. Once its position is confirmed via Doppler Ultrasound and visually via the laser’s light under the skin, tumescent anaesthetic is given along the entire length of the saphena vein making sure all the veins around it are anaesthetised too. The anaesthetic solution has to create a liquid solution along the length of the vein, surrounding veins and tissue as the heat created by the laser can reach very high temperatures which can cause pain and burns. Once the anaesthetic has created a liquid cushioning, the catheter is pulled with the laser in either pulse or constant mode, causing the vein to shrink and close.
Your doctor may opt to remove varis pake (plaque???) that can reduce the clarity of Doppler Ultrasounds and cause pain with a mini-phlebotomy via a minor incision which can be closed with an incision strip. Following the procedure, the vein EVLA has been performed on is rescanned with a Doppler Ultrasound which should show the vein has been completely destroyed. This scan is then used to compare with later scans taken during check-ups. Finally, the patient’s leg is wrapped with an elastic bandage before being discharged.
EVLA is not suitable for pregnant women, people with leg artery complaints, immobile patients, people suffering from deep vein thrombosis, or those predisposed to thrombosis or bleeding.
Side effects associated with classic surgical treatments are rarely seen and when so are very tolerable.
These side effects include:
EVLA treatment lasts around 30-45 minutes. Compared with classical surgical procedures, EVLA causes much less pain and bruising and causes no bleeding while leaving no incision scars meaning that dressings are not needed after the procedure and that the risk of infection is virtually zero.
Following the procedure, patients don’t generally feel the need to take painkillers and can return to their normal lives with just a minimal amount of pain. It is important to avoid strenuous exercise, be it fitness or weightlifting, for 2 months following the procedure for its long-term success.
The patient’s leg is wrapped in an elastic bandage for 2 days and who is then recommended to wear a varicose stocking for 2-3 weeks until a complete recovery is made. The patient is made to move a few hours after the procedure, ensuring they can return to their normal lives the next day. Generally, there is no need for painkillers.
According all available data, EVLA treatment is a very safe and effective varicose vein treatment method. The data provided by many health centres using EVLA shows a success rate of 95-98%. A meta-analysis of data published in 2009 of 12,300 patients treated for varicose veins indicated a success rate of 94% with classical surgical treatments having a success rate of just 77%.
Saphena veins in the legs can be used in heart bypass surgery and a prerequisite of their use in a heart bypass operation is that these veins are of a normal diameter. However, these veins of people with varicose vein complaints are generally wider and thicker than normal, meaning they are not suitable for a bypass operation. Additionally, coronary bypasses are today successfully performed using saphena veins in the chest and hands. It is thus for this reason that such patients shouldn’t have varicose vein treatment in case these veins are needed for a future heart bypass.
Here it should be mentioned that EVLA treatment involves inserting the catheter via the knee and passing it along to the groin while preserving healthy veins that could later be used for a heart bypass.