Endovenous Laser Treatment (EVLT)

 

Ultrasound is used to mark the course of the vein to be treated before the procedure is undertaken. The vein is then punctured under local anaesthetic using a needle through which a guide wire is fed. A plastic catheter is inserted over the guide wire along which the laser fibre can be introduced. The tip of the laser fibre is carefully positioned at the top end of the saphenous vein. Quite a large volume of local anaesthetic is then injected around the vein to compress it around the laser fibre. The laser is then activated and slowly withdrawn along the abnormal segment of vein before being removed. The whole procedure is monitored using ultrasound to ensure the accuracy of the laser treatment.

Following treatment of the main vein trunk any additional bulging varicose veins can be treated either at the same time or delayed a few weeks, to see how much they shrink. In many cases treatment of the main vein trunk will sufficiently shrink the bulging varicose veins so no additional treatment is necessary. If not they are treated by tiny stab incisions to hook out the veins under local anaesthetic or foam sclerotherapy.

Following laser treatment, a firm compression bandage is applied and you are able to start walking almost immediately. The bandage is left in place for 24 hours and then is replaced by an elastic stocking which should be worn for two weeks, although it can be removed for bathing and showering.

A follow up appointment will normally be arranged about a month later to assess the effect of laser on the main saphenous vein and if necessary to plan treatment of any residual bulging veins.


Is it painful?

The amount of discomfort and bruising does vary according to whether bulging varicose veins are treated by phlebectomy (hooking out through tiny stab incisions) at the same time as laser treatment or left for subsequent injection treatment. The discomfort and bruising from treatment of the main saphenous trunk by laser is considerably less than conventional surgical stripping. There is also no incision at the groin or behind the knee which also significantly reduces the amount of pain. Some discomfort for the first few days though is to be expected but simple tablet painkillers such as ibuprofen usually control this very satisfactorily.


Time off work

A few days off work is probably sensible after laser treatment of the saphenous vein. Walking though is very good for you but it is not wise to exercise vigorously for a couple of weeks after treatment.


Are there any risks?

As with all medical or surgical treatments there are slight risks. Some of these are similar to the risks of conventional surgery where the saphenous vein is stripped out but generally the risks are less. There is a slight risk of deep vein thrombosis with any treatment of varicose veins but the evidence we have at the moment suggests that this is significantly less with EVLT than with conventional surgical treatment. There is also a slight risk of damage to sensory nerves which sometimes run close to the treated vein. This can leave small numb patches although this often recovers fully. Very rarely there can be slight damage of the skin overlying the treated vein but this should not occur if adequate injection around the vein has taken place at the time of treatment. Some bruising along the line of the treated vein can occur but again this is much less than associated with stripping of the saphenous vein.


How successful is laser treatment?

The vein treated is a main vein trunk where valves have failed, leading to the development of varicose veins. The aim of laser treatment is to block or obliterate that main vein trunk and this is successful in at least 95% of cases. Residual bulging varicose veins may need some additional treatment. Endovenous laser treatment has only been undertaken in significant numbers of patients for about five years so long term follow up beyond this time scale is unknown. There is no doubt that with all treatments of varicose veins there is a risk of recurrence and with conventional surgery this is probably at least 20% in the long term. Follow up of patients after EVLT suggests that the recurrence rate, at least in the early years, is comparable to conventional surgery and possibly slightly less. As with all new treatments it is not possible to guarantee that these good results will be maintained in the longer term although it seems likely that they will.