Endovenous Laser Ablation

EVLA is a breakthrough in modern management of varicose veins. This technique has been in use for approximately 19 years in the USA and Europe and 17 years in Australia.

This technique is used to seal off the incompetent (not working) Saphenous veins. Saphenous veins are the major superficial veins of the legs, running either on the inside of the leg from the ankle to the groin or at the back of the leg from the ankle to behind the knee. Please note that Saphenous veins ARE NOT “Deep Veins” and the body functions extremely well without them. When they stop working they can cause a lot of damage to the legs. 

This damage may appear as swelling, itching, cramps, pain (heaviness or aching), skin darkening (pigmentation), eczema, hardening of the skin and fat (lipodermatosclerosis) and eventually ulceration. Most of this can be prevented when the abnormal Saphenous vein is removed or sealed off. 

Surgical stripping involves the removal of this abnormal vein. Ultrasound Guided Sclerotherapy (UGS) and EVLA are techniques that seal off the vein, leaving the body to absorb it over time. 

EVLA requires a combination of laser and ultrasound technology. Patients do not require admission to a hospital or general anaesthesia. Research performed on more than 1000 patients has shown a low risk of complications and superior results when compared to surgery and UGS (excellent results in over 90% of patients). 

EVLA is used to treat the main trunk of the Saphenous vein. Following EVLA, the branch veins still require some form of treatment. This is usually performed at the same time as the laser procedure. 

Treatment of these remaining veins can be performed in two ways. The first involves “Ultrasound Guided Sclerotherapy”, where the doctor injects a solution into the large veins under the surface of the skin. The ultrasound allows the doctor to “see” the vein so it can be injected safely.

Another option is Phlebectomy, which involves the removal of larger veins through small cuts in the skin. This is usually performed after the injections, which help to “shrink” the veins so they can be removed through a smaller incision. While parts of the vein may sit close to the surface, sections of the same vein may not. The injections also help to close off any part of the vein that may remain following the Phlebectomy.

Although this may leave a small scar (approximately 2mm in length), it can lead to overall faster healing times in some people. 

Both forms of treatment can be discussed at the Vein & Laser Centre, to help patients decide on the best treatment in their particular case. 

 

What should you do before EVLA?

Do not apply moisturiser to your legs on the day of treatment. Wear slacks or loose trousers and sandals or loose shoes to the clinic to allow for the thickness of the stocking and outer bandage. 

 

What happens during EVLA?

You will be asked to present 10 mins before the procedure. An ultrasonographer will perform a scan of the leg similar to the initial screening to familiarise us with the pathway of the vein to be treated. This will be marked on the skin surface with a marking pen.

The procedure is performed with you lying on a treatment couch. Ultrasound will be used to locate the abnormal vein. The vein is punctured through an area of skin that has been anaesthetised with a small amount of local anaesthetic. The puncture allows the introduction of the laser fibre inside the diseased vein. 

Local anaesthetic is then injected around the vein at several points using extremely fine needles directed by ultrasound. These injections are performed using ultrasound to “see” the vein and the surrounding tissues. The laser tip is precisely positioned using ultrasound guidance. The laser probe is then turned on and slowly withdrawn, destroying the full length of the vein. The procedure involves minimal discomfort. Following the laser treatment, the branch veins are usually treated in the same session using UGS and/or Phlebectomy. Compression stockings and bandages are applied at the end of the treatments. 

It is routine practice to perform a check ultrasound scan within the first week after the treatment, to make sure that the treated vein is closed and to rule out the very small risk of blood clotting (DVT). Any remaining branch veins may also be identified at the time of this scan. They will usually be treated with UGS at your one month visit. 

     

 

What can you expect following EVLA?

The following features are expected and do not need to be reported:

  • Bruising down the length of the treated vein almost always happens and should not be a cause for concern.
  • Mild to Moderate Pain often occurs, starting a day or two after treatment. Aching in the leg persists for up to 2 weeks and shows that the procedure is working. Pain is usually improved by walking and/or Nurofen. Soreness behind the knee can result from rubbing by the stocking or the bandages. Should you experience severe pain that is not relieved by walking, and means that you are limping, please contact the Vein & Laser Centre.
  • Discolouration is usual early on and is not a cause for concern. Red, raised areas can develop over the treated veins but these usually disappear within 2-3 weeks.
  • Tender Lumps due to trapped blood in the treated vein is common and persists for the first few weeks. The doctor may remove this at a follow-up visit.

What are the possible complications from EVLA?

Adverse reactions for EVLA do not differ much from those for UGS. Complications occur even with perfect technique. Please refer to the Information Document for further details on the complications of EVLA. 

Do the treated veins come back?

EVLA has been shown to be the most effective treatment for varicose veins when compared with surgery and sclerotherapy. It is important to note that EVLA is treating the TRUNK of the varicose vein and not the branches. The branch veins are treated with ultrasound guided injection and/or phlebectomy. 

Follow-up

It is important to follow-up the treated vein with ultrasound imaging to detect signs of early recurrence in branch veins. Our follow-up includes ultrasound examinations at 1 week and 4 weeks, at which time any remaining veins are treated. 

As part of our ongoing commitment to improving our laser treatments, you may be contacted in the future and invited to participate in a follow-up ultrasound scan to determine the long-term outcome of the treatment. We would appreciate your participation if possible. 

 

Compression Stockings

All treatments performed at the Vein & Laser Centre require the wearing of a Class 2  compression stocking after the procedure for a variable amount of time. The length of time the stocking needs to be worn varies from 5 days to 2 weeks depending on the size of the veins injected and the treatment method provided. The stockings may be claimable from your health fund if you have ancillary cover.