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Endovenous Laser Therapy (EVLT)

Endovenous Laser Therapy (EVLT)  

Endovenous laser treatment gets rid of varicose veins by utilising an optical fibre. This is inserted into the leaky vein to be treated. Laser light, normally in the infrared portion of the spectrum is shone into the interior of the vein. This heats up the vein causing it to contract and loose its lumen. This means that blood will no longer be able to keep leaking back through this vein.

This makes it a quick, minimally invasive procedure which closes the faulty vein leaving no scarring. It has a short and relatively pain-free recovery period. It is usually performed under local anaesthetic. The treatment itself will usually take less than an hour and you can return home shortly after the procedure is finished. Normal activities can be resumed immediately, and you should be able to return to work within a couple of days.

How is EVLT performed?

The procedure takes place in an out-patient setting. The main steps in the procedure are as follows:

  • your leg will be draped and disinfected
  • under ultrasound guidance a needle will be inserted into the leaky vein followed by a flexible guide wire
  • a special long flexible tube (catheter) will be passed over this wire into the vein within the leg
  • the wire will be removed and replaced with the flexible optical fibre through which the laser light will pass
  • using ultrasound, the tip of the fibre will be positioned at the correct start point for the treatment within the vein (most commonly in the groin)
  • local anaesthetic is injected along the line of the vein to numb the treatment area. This is also guided using ultrasound
  • you will be provided with special glasses to wear (These protect your eyes if the laser had to accidentally be activated outside the vein). You may
  • the laser will be audible as a beep once activated
  • the laser fibre is slowly withdrawn closing the vein behind it
Depending on what had been agreed with the surgeon treatment may or may not continue at this point to remove the visible varicose veins remaining in the leg.

Is loss of this vein a problem?

No. There are many veins in the leg and after treatment the blood in the faulty veins will be diverted to other normal veins in order to make its way back to the heart.

Post Operative Care

Immediately following the procedure, a compression stocking will be fitted. This needs to be kept on for 2 to 5 days. You may return to normal activities immediately following the procedure. Hot baths and vigorous gym workouts should be avoided. Discomfort during the procedure is minimal.

How does the procedure actually work?

The laser passes through the fibre into the faulty vein and damages the vein walls by heating them up. This causes shrinkage, closing the vein so that the blood can no longer flow through it.

Is loss of this vein a problem?

No. Blood in this vein was flowing in the wrong direction and so it will not be missed. There are numerous other veins in the leg and after treatment the blood in the faulty veins will be diverted to other normal veins in order to make its way back to the heart.

What are the potential complications of the procedure?

There are potential complications with any medical procedure, however serious complications following EVLT procedures are rare. Bruising is common after laser treatment. This may appear during the first few days but it will disappear over the next two to six weeks. Aches, twinges and areas of tenderness may be felt in the legs for the first two weeks after the operation. These will settle down and should not discourage you from becoming fully active. Tender lumps under the skin are also common and are the remains of the sealed vein. They are not dangerous and will be gradually absorbed by the body. This can take several weeks.

Deep vein thrombosis (DVT)

causes swelling of the leg and can result in a blood clot passing to the lungs. It is a possible complication after any surgery, but it is particularly unlikely if you start moving your legs and walking frequently soon after the operation. At the Manchester Vein Centre, it is standard practice to given an injection of a medication called Clexane. This medication is known to reduce the risk of developing a DVT following surgery.

Am I at risk from the laser?

If viewed directly the laser light can cause eye damage. This is why we provide you with a special pair of glasses to protect your eyes. This is just a precaution against accidental firing of the laser energy outside the body.

What is the alternative to this treatment?

Traditionally, faulty leg veins have been treated with surgical ligation and stripping. This involves at least two surgical incisions in order to tie off and pull out the faulty vein. It is usually performed under general anaesthesia. At the Manchester Vein Centre it is our opinion that open surgery no longer has role in the management of varicose veins. Alternatives to EVLT are radiofrequency ablation and Clarivein.

Will my varicose veins return?

By treating the underlying cause of your varicose veins you have the best chance of them not recurring. There is evidence that the chance of the veins returning are much less with EVLT when compared with tradition surgery.

Will I need pain killers?

You may need to take painkillers such as paracetamol or Ibuprofen You should not need them for more than a few days, but the duration of discomfort varies from person to person.

When can I drive a car?

You can drive as soon as you feel confident that you can make an emergency stop without pain. This is usually the next day following the procedure.

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