Sclerotherapy and Laser Ablation for Varicose Venis

EVLA- Endovenous Laser Ablation

EVLA is the latest method for the treatment of major veins, previously treated by "stripping" surgery.
With ultrasound guidance, a laser fibre is placed into the abnormal vein through a tiny incision. The vein is then numbed with local anaesthetic, and the laser activated as the fibre is slowly removed. This produces a reaction in the vein wall along the treated section, resulting in collapse and sclerosis of the vein wall with minimal discomfort.
The published success of EVLA treatment is between 95-98%, with far fewer complications than surgery. With the addition of EVLA to Ultrasound Guided Sclerotherapy, it is expected that varicose vein surgery will be performed much less frequently in the future.

A duplex ultrasound is used to map out your vein.
Local anaesthetic is then applied.
A thin laser fiber is inserted through a tiny entry point, usually near the knee.
Laser energy is delivered to seal the faulty vein.
Walking immediately after the procedure is encouraged. Normal daily activity can be resumed right away - just avoid rigorous activities such as gym workouts.
There may be minor soreness and bruising. Any discomfort can be treated with over-the-counter, non-steroidal anti-inflammatories only after consultation and discussion

How does EVLA work?
The laser energy damages the vein walls, shrinking them and closing the faulty vein so that the blood cannot flow through it. This eliminates vein bulging at its source.
Is loss of the vein a problem?
No. After treatment, the blood in the faulty veins will be diverted to the many normal veins in the leg.
Am I at risk from the laser?
No. Just as a precaution against accidental firing of laser energy outside the body, you will be given a pair of special glasses to protect your eyes.
How successful is EVLA
Published clinical studies show that EVLA has a 98% initial success rate with excellent long-term results.

Excellent Alternative to Saphenous Vein Stripping (Surgery).
Performed under local anaesthesia.
Minimal to no discomfort.
No admission to hospital or general anaesthesia.
Minimal time off work or interference with normal home duties.

Both legs can be treated in the one session.
Surface varicosities are treated at the same time with Ultrasound Guided Sclerotherapy.
A sonographer or doctor will mark out the vein(s) to be lasered.
A localised Nerve Block will be performed to anaesthetize the area of the leg to be treated.
You will lie comfortably on the examination couch with your leg externally rotated if treating the Great Saphenous Vein. If treating the Small Saphenous Vein, you will be asked to lie prone.
A small Catheter is introduced through a small needle, into the disease vein.
A Laser Fibre is then passed through the catheter and into the vein and strategically positioned with Ultrasound Guidance, so that the laser tip is just below the top end of the vein. The laser fibre is connected to a 1500 nM Laser Machine.
Local anaesthetic known as “Tumescent Anaesthetic” is infiltrated around the vein with Ultrasound Guidance, at several levels through the anaesthetized skin.
The Laser Fibre is then activated and slowly withdrawn by an “Automatic Pull Back Device”, thereby destroying the full length of the vein.
The procedure at this point should be completely painless.

Class 2 Compression Stockings will be applied by our Nurse.
 You will be directed to go for an immediate 20-30-minute walk before you drive home. As
long as you are able to walk unaided without restriction, you are allowed to drive home.
 The stockings will be worn overnight for the first night.
 Following this, the stockings should be worn for a minimum of 14 days but only during
the day. They can be removed for showering or when going to sleep at night.
 Walking for 30 minutes each day is mandatory.
 Maintain normal daytime activities but avoid standing still for long periods of time.
 Continue with normal exercise activities.
 An ultrasound check of the lasered veins will occur 1 month after the treatment. This is to assess the outcome of the treatment and also to exclude the very low chance of deep vein occlusion.

The following features are expected. They are not a cause for concern although they should be reported at review:
Mild to moderate pain persists for 1-2 weeks along the lasered vein. Post EVLA discomfort should be managed with a combination of light walking and rest (with leg elevation), anti-inflammatory medication such as Nurofen or Voltaren and stocking wear.
Phlebitis or inflammation may occur along the inner thigh in line with the lasered vein. This is again managed with anti-inflammatories and stockings. Dr Paraskevas must be contacted if this occurs.

Complications can occur even with perfect technique.
Deep vein thrombosis. Internal Vein clots are extremely rare following EVLA. Pulmonary Embolus, although reported in the literature, is also very rare.
Nerve damage. Damage to surface sensory nerves can occur but this usually returns to normal within weeks to months. Persisting numbness is more common after surgical stripping of the saphenous vein below the knee. It is possible to inadvertently damage the Saphenous Nerve during below knee EVLA. Damage can rarely occur to nerves behind the knee causing motor damage.
Skin burns have been reported but have never been encountered in our practice.