Endovenous Laser Ablation (EVLA) is a minimally invasive, more desirable alternative for the treatment of painful, unsightly varicose veins. With a 98% effective rate, varicose veins can be removed in the office and the procedure allows patients to return to normal activity immediately.
Advantages of Endovenous Laser Ablation
- Higher success rate
- Safer - Less risk of complication
- Easy and quick procedure – much improved due to latest technology
- Local anesthetic only – no general anesthesia
- You can drive yourself to the procedure and home from the procedure
- In-office procedure – no surgery center
- Less bruising
- Very comfortable procedure – Minimal pain
- Minimal post-procedure discomfort
- Return to normal activity immediately
“This is not the procedure my grandmother had! Had I known it was going to be this easy, I would have done it sooner” – Elizabeth S. Actual patient
While ligation and stripping was once considered the primary treatment for varicose veins, it has quickly become outdated and unnecessarily invasive. Ligation and stripping was performed under general anesthesia and required up to two weeks of recovery time before patients could return to work. Many patients also experienced pain and discomfort during and after the procedure, as it involves pulling the damaged veins out through several incisions in the leg. Some vein centers are still performing vein stripping. If you have been told you need vein stripping please get a second opinion.
New technology has allowed doctors to develop less invasive alternatives such as EVLA. EVLA uses laser energy to heat damaged veins and seal them shut. This is done through a tiny puncture in the leg that does not even require suturing, but still offers patients permanent, effective removal of damaged veins. EVLA is ideal for nearly any patient with large, painful varicose veins. Your doctor will perform an ultrasound exam in order to determine if this procedure is right for you. EVLA can be performed for medical or cosmetic purposes.
EVLA stands for endovenous laser ablation. It is an effective method for getting rid of varicose veins, a condition caused when vein valves do not close correctly, and 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. About 50% of patients with venous disease get a deep venous thrombosis (DVT) and about 50% get an ulcer.
During the EVLA procedure, the skin is numbed with local anesthesia, a tiny laser fiber is inserted into the skin and guided to the saphenous vein through ultrasound imaging. The vein is surrounded by an anesthetic liquid and then the laser fiber gently closes the vein as the fiber is removed. This part of the procedure usually takes two or three minutes and is painless. Now that the vein is closed, the abnormal high pressure in the leg is reduced immediately, making it easier for the surrounding healthy veins to do their job returning blood to the heart. The normal pressure in the leg helps reduce the chronic congestion in the leg, the symptoms decrease and leg returns to normal health. The entire procedure takes less than 25 minutes and you are usually in and out of the office in about an hour.
Not All Endovenous Thermal Procedures Are The Same
Not all endovenous thermal procedures are the same. Some of the earlier lasers actually cauterize the vein. The cauterization can create more post op discomfort. California Vein Specialists uses only the latest, most gentle laser frequency (1470 with a radial head). Dr. Leary also uses the Venous ClosureFast, also known as Venefit, which is powered by radiofrequency (RF), delivering heat to the vein wall. As the thermal energy is delivered, the vein wall shrinks and the vein is sealed closed. This method is also very gentle with very little post op pain. Every procedure is tailored to the particular needs of the patient. Some patients will be better candidates for laser, while some may be better candidates for radio frequency. Dr. Leary will discuss and recommend which of these options he feels is best for each individual patient.
EVLA addresses the source of varicose veins without an invasive surgical procedure like ambulatory phlebectomy, ligation and stripping. 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 EVLA
Patients with arterial 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. This minimally invasive procedure is an excellent choice for a large number of patients that are at higher risk for surgery; for example diabetics and patients on blood thinners.
Before EVLA Begins
A physician evaluation, including a medical history, physical exam and ultrasound are required before EVLA. Additionally, you will be prescribed post-surgical compression hosiery for five days. Just before the procedure, patients are asked to shower with antibacterial soap.
What to Expect
EVLA 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 EVLA 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.
Activity is encouraged following the procedure, the patient should walk several times per day for at least 20 minutes. Patients must wear a Grade 2 compression stocking for five days and are allowed to shower with the compression stocking on. A shower cover can be helpful to keep the compression stocking dry. Restrictions may be imposed, such as heavy lifting over the head and jogging. Patients are allowed to use a treadmill, and are allowed to do yoga and Pilates after the procedure. Painkillers like ibuprofen, acetaminophen or Aleve may be taken as needed, but usually are not needed. Sometimes mild stiffness and soreness are felt but usually disappear within two weeks.
A second ultrasound will be performed two weeks after EVLA and additional physician follow-up appointments will be necessary. Sclerotherapy, if needed, is usually started within two weeks. Most of our patients are advised to come in for yearly ultrasound evaluations.
Recovery and Results
After the EVLA procedure, patients will be able to return home and to normal activities right away. Most patients return to work the very next day, although exercise and strenuous activity should be avoided for a few days. There is no stitching or suturing needed after this procedure. The puncture is small enough to heal on its own and leaves virtually no scarring.
EVLA provides permanent removal of varicose veins through a minimally invasive procedure with no downtime. In order to maintain the results of this procedure and to prevent further damage from occurring, patients are encouraged to lose weight, engage in a healthy and active life, and have an ultrasound on your veins yearly for early detection.
While EVLA is generally considered safe, there are certain risks associated with any surgical procedure. Some of these risks include infection, bruising, bleeding, clotting, puncturing and thermal damage. These risks are considered rare and most patients undergo the procedure with no complications.
If you are interested in learning more about EVLA, please call our office to schedule a exam. (949) 515-9377. There is no reason for you to be living with painful, unsightly varicose veins any longer, and relief is now available through this safe, minimally invasive procedure.
*Any claims regarding the duration or outcome of any treatment, procedure, or service provided are based on optimal results. Individual results may vary. For realistic expectations, please set up a one on one exam with our practice.