What is Endovenous Laser Therapy?
Endovenous Laser Therapy (EVLT) refers to the insertion of a laser fibre inside a main leg vein and then the use of a laser internally to close off the faulty vein.
How new is the treatment?
Internal laser treatment to close large veins was first described by Navaroo and Min in 2001. It has been used in Australia since 2002.
What is the difference between EVLT and EVLA?
Although the term EVLT has become synonymous with internal laser treatment of veins it is in fact a registered trademark EVLT?? for a specific laser kit produced by the company DIOMED. The generic name of the procedure should be EVLA (Endovenous Laser Abaltion) since the procedure can be performed with other manufacturer’s equipment.
Why can’t an external laser be used?
Applying a laser to the outside of the skin is only effective for very small superficial veins. For more information see Laser Treatment of Veins. To effectively try and close larger and deeper veins the laser has to be inserted under the skin.
What type of laser is used?
There are 2 main groups of lasers used for EVLT. One group is DIODE lasers at a wavelength of 810 or 940nm which are designed to try and maximise the absorption peak of haemoglobin in the blood. The second group is YAG lasers at a wavelength of 1320nm which can penetrate through blood and be more strongly absorbed in the collagen of a vein wall.
What are the advantages of EVLT?
- Minimally invasive
- Quick: EVLT takes up to an hour
- No hospital admission
- Local anaesthesia (no general anaesthesia)
- No stitches and no surgical scarring (4mm puncture wound)
- Return to normal activity the next day
- High safety profile
How is EVLT done?
Local anaesthesic cream is applied to the skin over the veins for half an hour.
The prophylactic Clexane (40mg) is administered subcutaneously pre-procedure.
The relevant vein is punctured at about the knee or the ankle.
A thin guidewire is passed up the vein, a 45cm catheter is passed over the wire, and the laser probe is introduced through the catheter
Local anaesthetic is infiltrated around the vein at several levels using a fine needle (25gauge) directed by ultrasound.
The laser tip is precisely positioned and then activated and slowly withdrawn destroying the full length of vein.
What do I need to do after treatment?
You must go for a 30 minute walk immediately after treatment and at least 30minutes daily for two weeks.
Usual daytime activities can be continued with avoidance of standing still for long periods. Avoid strenuous physical activity such as aerobics for one week after treatment. Airline flight should be avoided for 4 weeks post therapy. If unavoidable then cover with Clexane injection may be advised. Stockings are worn continuously for 7 days and then for a further 7 days during the day only.
It is routine to perform a check ultrasound scan at 14 days after EVLT.
What do I notice after treatment?
Bruising down the length of the treated vein.
Mild pain persists for several days and can persist for up to 2 weeks. It shows that the treatment is working. Pain is managed with walking, Anti-inflammatories such as Naprosyn and Paracetamol as necessary.
Discolouration is usual early on and is not a cause for concern. Red, raised areas can develop over branch veins but these usually disappear within 4-6 weeks. Tender lumps due to “trapped blood” in the treated vein are not uncommon and persist for the first few weeks. The doctor can remove these by needle puncture if they are causing undue discomfort.
Inflammation or phlebitis of the treated veins can occur. Management includes further compression, anti inflammatory medication and regular walking.
What are the possible complications?
Possible complications from EVLT occur even with perfect technique.
Pigmentation can occur along the treated veins. This is caused by Haemosiderin, which is a form of iron from the blood. This typically disappears within 12 months but there is permanent staining in about 5% and this can be of cosmetic significance. Persistent pigmentation may respond to laser treatment.
Deep Vein Thrombosis – clots extending into the deep vein can occur but this serious complication is extremely rare if the protocol of compression and regular daily walking is followed. Women are sometimes advised to stop oral contraceptives prior to EVLT to reduce the risk of deep vein thrombosis.
Nerve damage – The adjacent sensory nerves can suffer heat damage causing numbness but this is usually mild and rarely lasts for more than a few weeks.