Questions & Answers

If I have had large vessels such as the saphenous closed, is there chance of circulatory problems later on?

Endovenous laser ablation is minimally invasive and very safe. The worst complication would be a blood clot in the leg. This is very rare complication compared to any surgical procedure. In answer to your second question, if the larger saphenous vein is refluxing, or non functioning, the blood has already by- passed that vein. So when you close it off, it will actually make your leg health improve and help preserve the normal veins. The long term venous health will improve if the vein is ablated, but if untreated, will only become worse.

Mapping of a vein is done prior to any EVLT procedure. Ultrasound is done prior to even minor procedures such as sclerotherapy. This eliminates the possibility of missing an important refluxing vein. The EVLT procedure is done entirely under ultrasound guidance.

What is EVLT?

EVLT stands for endovenous laser treatment. It is an effective method for getting rid of varicose veins, a condition caused when vein valves do not close correctly, thereby allowing blood to pool in the affected area. Veins begin to bulge as blood pushes against the vein walls. The result is painful, causing legs to ache and swell. In worse case scenarios, varicose veins can lead to unnecessary bleeding and eczema or ulceration.

Choosing EVLT

1.                 EVLT deals with the source of varicose veins without an invasive surgical procedure like ambulatory phlebectomy, ligation and stripping or sclerotherapy. It uses a fiber laser energy probe, guided by ultrasound, to deliver impulses to the affected area. It is highly effective, working 98 percent of the time.

Non-Eligibility for EVLT

 

2.                 Patients with heart disease or blood disorders may not be eligible for this procedure. Pregnant women are not immediate candidates either since, in many cases, temporary varicose veins disappear after pregnancy.

Before EVLT Begins

 

3.                 A physician evaluation, including a medical history, physical exam and ultrasound are required before EVLT. Additionally, most physicians want to approve post surgical compression hosiery at that time. Just before the procedure, patients are asked to shower with antibacterial soap.

What to Expect

 

4.                 EVLT is done out patient and takes less than thirty minutes The patient can usually drive themselves to the office and drive home.   Only a local anesthetic is given before EVLT begins. Patients are also offered a pair of protective glasses to wear. Then, a small catheter is threaded into the vein entering usually from below the knee. The laser fiber is gently advanced through the catheter and, once in place, uses its energy to seal off the vein. Then the laser fiber is removed, the wound dressed, and compression hosiery applied. The procedure is very gentle, the only discomfort felt are a few pinches during local anesthetic administration.  Our newer lasers are very gentle and patients experience very little or no pain after the procedure.

After EVLT

 

5.                 After the procedure, the patient must walk on a treadmill for roughly 15 minutes. Activity is encouraged following the procedure. Patients cannot remove compression hosiery for five days and are allowed to bath with the Compression hosiery left on. Restrictions may be imposed, such as heavy lifting over the head and from jogging. Patients are allowed to use a tread mill, and yoga and Pilates are ok. Painkillers like ibuprofen or acetaminophen may be taken as needed, but usually are not needed.  Sometimes mild stiffness and soreness are felt but usually should disappear within two weeks.

A second ultrasound may be performed at two weeks after EVLT and additional physician follow-up appointments will be made. Sclerotherapy if needed is usually started with in two weeks.  Most of our patients are advised to come in for yearly ultrasound evaluations.

Foam sclerotherapy is a good alternative to EVLT, but I find that the laser ablation is more complete. Over ninety nine percent closure rate. I also find it to be less painful then foam procedures, especially when using the newer laser frequencies such as the 1470. Nerve injury would be a very rare complication from the EVLT. The only nerve injury we have ever encountered is a temporary superficial numbness. This usually resolves in a few weeks and again is very rare. I find the laser the best way to close the large saphenous vein, and the foam procedures are best to close the connecting trunk veins. So a combination of the two procedures is ideal. This avoids all surgery.