Endovenous laser therapy for varicose veins (EVLT)

Endovenous Laser Treatment EVLT offers patients several advantages:

• Reduced postoperative pain and bruising results in an earlier return to normal activities
• Usually done under a local anaesthetic
• The patient walks out of the treatment room and may go home ten minutes later
• 98 % have total obliteration of the incompetent saphenous vein when reassessed at five years
• No general anaesthetic, groin incision, wound infection or need for overnight stay

Who is suitable for Endovenous laser treatment (EVLT)?

Overall about seven out of ten patients are suitable to Endovenous Laser Treatment (EVLT) and the remainder will require daycase surgery. It is essential to carry out a venous duplex scan to decide whether EVLT is the best option. EVLT is not appropriate for a saphenous vein which is kinked or tortuous or of small calibre, as it may not be possible to position the laser fibre correctly. It is also best avoided if the vein has been affected by thrombophlebitis.

How is EVLT done?

The patient walks into the room and the position of the long saphenous vein is marked from the groin to just below the knee using a duplex scanner. The distal vein is then entered with a needle and the laser fibre threaded up so that it lies very close to the saphenofemoral junction. The scanner accurately confirms the exact position of the fibre tip. The entire length of the saphenous vein is then surrounded by a column of dilute local anaesthetic, which is injected at several points in the thigh. This reliably obliterates pain and also acts to soak up the heat generated by the laser.

Finally the laser fibre is activated and slowly withdrawn to achieve total thermal obliteration of the whole length of the incompetent saphenous vein.

How long does the Endovenous laser treatment procedure take?

The Endovenous laser treatment procedure takes about fifty minutes overall. In some patients it is desirable to also avulse some veins through tiny skin incisions to achieve the best possible cosmetic outcome. EVLT is also used to treat the short saphenous vein in the posterior calf.

What are the results?

Endovenous Laser Treatment (EVLT) is more effective than surgical high tie and stripping in achieving effective obliteration of the incompetent saphenous vein, which is the underlying cause of varicose veins. Following EVLT most patients will notice that there has been a massive improvement in the state of their varicose veins. In a small proportion of subjects however some veins may persist despite treatment of the root cause. Residual veins can be tidied up either by simple removal under local anaesthetic or injection of a chemical foam (sclerotherapy).

Another approach is to perform EVLT under a general anaesthetic, which allows the surgeon to remove the individual varicose veins through minute skin incisions. Scarring is minimal.

Post treatment Information

After EVLT some induration and discolouration of the thigh is to be expected. Transient bruising may also occur. These events are rarely troublesome and will settle rapidly. It is usual for a sensation of tightness to develop in the treated area after about 48 hours. This responds well to anti-inflammatory drugs, which are routinely prescribed. It is often possible for the patient to return to work on the following day. EVLT is a very safe procedure and complications are uncommon.