Varicose Veins

   

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Evlt

(Endo Venous Laser Treatment)

Trials to deliver laser energy inside veins were initiated in Spain in 1999.  The procedure was approved by the FDA in the USA in January of 2002.  The technique was started in Canada in 2003.  EVLT is a quick, minimally invasive procedure that is performed at the doctor's office.  It only leaves a single tiny scar.  The procedure is performed under local anesthetic

 

Before the Procedure:

DONíT:

  • Donít wear the stockings for at least 24 hours
  • Check with the treating physician if you are taking blood thinners
  • Donít take Iron supplements for 7 days
  • Donít consume Alcohol or caffeine containing products for 24 hours

Donít forget to bring your stockings the day of the procedure

 

The Procedure

  • A digital photo of your leg may be taken
  • Takes about one hour per leg
  • Your veins will be mapped with ultrasound
  • You will then lie down and the leg will be cleaned with antiseptic solution
  • The leg will be covered with sterile drapes
  • All materials are sterile and disposable (single use)
  • Local anaesthetic (freezing) is injected at the entry point
  • A needle is placed through the frozen skin into the centre of the vein to be treated.  Occasionally this step induces vein spasm to the extent that the vein diameter becomes smaller than the needle.  If that is encountered, an attempt will be made to enter the vein at a higher point.  If the higher segment goes into spasm too, it will not be feasible to get access to the inside of the vein and the procedure will be postponed to another day.  This is a very uncommon encounter
  • A small cut (2-3mm) will then be made and a flexible guide wire will be inserted into the vein.  You may feel the wire moving, but this is not painful
  • A tube will then be passed on top of the guide wire and the wire will be removed
  • The laser fibre will be threaded within the tube that has been inserted in the vein
  • All insertions are done under ultrasound guidance
  • Multiple injections of local anaesthetic will be used along the vein
  • The laser will then be turned on and- as a precaution- protective goggles will be worn.  Once the laser is activated, the tube together with the laser fibre inside it will be pulled out.  That part takes about 2-3 minutes.  Very occasionally, a transient sensation of heat is experienced; otherwise, that step is painless.  You might experience a barbeque-type taste or smell
  • A small band aid would then be applied to the entry point

 

After the Procedure

Do:

  • walk immediately for 30 minutes or so and daily for the first few days
  • Resume your normal daily activities
  • When seated elevate your legs
  • Drink plenty of non-alcoholic beverages
  • Ice packs over the lasered segment for 15 minutes every 2 hours for the first 2 days
  • Anti-inflammatory medications such as Advil helps control post-procedure discomfort

A full thigh compression stocking is to be worn immediately and for a total of 2 weeks.  Donít take them off for the first 2 days.  From day 3 to day 14, you may take them off when you are asleep or when you shower

 

donít:

  • Donít do strenuous exercise for the first 2 weeks
  • Donít stand for prolonged hours in the first few days
  • Donít use hot tubs for3-4 weeks

 

Expect:

  • Bruising is very common and resolves completely in about 1-3 weeks
  • Tightness along the treated vein felt as a ďpulled muscleĒ or as stiffness is experienced by almost every single patient.  It resolves by a week or so
  • The treated segment will appear red and swollen and will feel as a firm tender cord
  • Some of the superficial varicosities are direct branches of the treated vein and therefore shrink with time.  If not, these would be injected at a later date.
  • the majority of the time the lasered vein is not what you see on the surface meaning that the difference between before and after will be appreciated by symptoms improvement and also by shrinkage of some of the multiple branches on the surface of the leg
  • Ultrasound is the main follow up tool to check on success of the procedure and also to detect any further deep branches that might require sclerotherapy
  • Annual ultrasound is recommended to ensure long term success

 

Possible complications:

  • Superficial thrombophlebitis (inflammation with clotting of the surface veins) develops in 5% of patients and usually resolves with pressure stockings and anti-inflammatory drugs
  • Numbness occurs in 3% at the incision site and improves spontaneously
  • DVT (deep venous thrombosis) occurs in 0.3% of cases of which 10% will have the blood clot migrate to the lung and can be serious.  If you are diagnosed with DVT, you will require blood thinners for a period of 3-6 months When treated, less than 5% of DVT cases will migrate to the lungs with a death rate of about 1%.  If unrecognized, 25-60% of DVT may spread to the lungs with a death rate of 15% The DVT rate following EVLT is much less than that following surgical treatment of varicose veins
  • Allergic reaction to the local anaesthetic is uncommon but possible
  • The failure rate is in the range of 1-2%.  Those who fail the EVLT can be re-treated successfully with a second EVLT session

 

Relative contraindications:

  • Severe arterial disease where compression stockings could be contraindicated
  • Severe liver disease where the local anesthetic could be harmful to the liver
  • Pregnancy and lactation where safety is not known
  • Limited ambulation
  • Abnormal clotting

The long term outcome of the EVLT is not known yet


 
 

 

Conservative

Injection Sclerotherapy

Ultrasound Guided Sclerotherapy

Ambulatory Phlebectomy

Surgery

Endo Venous Laser Treatment (EVLT)