This is an abbreviated version of the complete article.*
Endovenous laser therapy (EVLT) is a minimally invasive procedure used to treat varicose veins.
Heat is applied to the affected areas via laser fiber, which ablates (destroys) the enlarged veins.
Although it is a newer treatment option, long-term success rates appear to be at or around 98 percent, which is as good or better than traditional surgical techniques.
During endovenous laser therapy (EVLT), a treatment for varicose veins, laser energy creates heat in a vein, which causes it to shrink and eventually disappear.
Varicose veins are a symptom of chronic venous insufficiency, which is common as people age. They are caused by a failure in the one-way valves that prevent blood from flowing backward into the legs. The resulting backflow, called reflux, and pooling of blood can lead to enlarged (varicose) veins. They are often visible through the skin of a person's legs as reddish or blue in color, and can cause symptoms.
EVLT is performed on an outpatient basis.
WHEN IS IT INDICATED?
EVLT is indicated in patients who:
Have varicose veins that cause symptoms;
Have circulatory problems because of chronic venous insufficiency;
Cannot have surgery to treat varicose veins because of other conditions or vulnerabilities; or
Wish to remove unsightly, enlarged veins.
The physician will perform a physical exam and take a medical history of the patient. The physician may advise the patient to refrain from taking aspirin or blood thinners prior to the procedure. The patient should be driven to and from the procedure.
WHAT TO EXPECT
The physician will first map all areas of reflux in the veins, using duplex ultrasound, and will determine the best place for the catheter to be inserted (usually just above or below the knee). He or she will clean, shave, and numb this area with a topical anesthetic. Once the anesthetic has taken effect, the physician will make a very small nick in the skin and insert the catheter and guidewire. More anesthetic is injected along the entire vein's length and the guidewire is removed. Next, the laser fiber -- which is a fine wire that carries electrical energy from a power generator -- is passed through the catheter until it protrudes approximately 1 to 2 centimeters (.4 to .8 inches) from the end, at which point it is secured in place. The patient may be asked to wear protective glasses when lasers are in use.
Ultrasound is used to confirm the location of the catheter and laser fiber prior to therapy. The laser may be activated manually by the physician or it may be set to fire automatic pulses every 1 to 2 seconds, depending on the case. The physician will apply pressure to the skin as he or she works along the vein. The laser energy seals the faulty vein and blood flow is re-directed to healthy veins. Because the affected veins are left in place, there is minimal bleeding and bruising. EVLT is not painful, but the patient may experience momentary discomfort if the laser is fired in an area near a nerve. The physician uses ultrasonography again after the procedure, to ensure that treatment was successful. The entire process does not usually take more than 1 hour.
POST-TREATMENT GUIDELINES AND CARE
The patient should not drive immediately after EVLT and should refrain from lifting heavy objects, but may resume all other activities right away. The patient must wear compression stockings following the procedure, and continuously for 1 week, but can remove them for bathing after 3 days. The physician may advise 30 minutes of walking each day post-procedure, and/or the placing of ice packs on the leg for 15 minutes each hour.
A follow-up appointment will most likely be scheduled within 24 to 72 hours, to evaluate results via ultrasound. If the main vein is not completely closed, another session of EVLT or alternate treatment may be planned. At 6 weeks, the patient will return for a second follow-up.
Bruising and tenderness generally follow EVLT. Serious complications have not been observed but include:
Skin coloring changes;
Nerve damage; and
Medical Review Date: December 7, 2009
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