Understanding Endovenous Laser Treatment (EVLT)

Introduction

Lasers have been used for numerous medical applications throughout the body. Recently, a novel technique utilizing laser energy delivered endovenously (directly inside the vein) has been developed to treat varicose veins. An 810 nm diode laser will be used to deliver the laser energy via a small laser fiber. Endovenous laser treatment of varicose veins (EVLT) is performed under local anesthesia in the doctor’s office. There is very little scarring, and a relatively short recovery period after the surgery as compared to conventional vein stripping.

Procedure Description

During the procedure, you will be given special eye goggles to protect your eyes against accidental exposure to laser light. Next, the treatment area will be marked and anesthetized with Lidocaine. A sterile laser fiber will be inserted into the vein and positioned under ultrasound guidance. Laser energy will be delivered to selectively treat the target vein. A compression dressing will be applied and must be worn for 2 days following the procedure. The dressing can be removed at home, but compression hose should be worn for at least 2 weeks following the treatment. You will return to the office in 2 weeks and the doctor will examine the vein with ultrasound and physical examination.

Risks

Results after EVLT have been excellent. It is important to remember that each patient’s results may vary. The potential side effects are thermal injury (burns) to the overlying skin or intervening tissue, perforation of the vein, breakage of the laser fiber, superficial phlebitis (inflammation of the vein), hyperpigmentation (darkening of the overlying skin), or neovascularization (growth of new veins). Deep venous thrombosis (DVT-blood clots forming in the deep veins), pulmonary embolism (blood clots traveling to the lungs) are also possibilities of any procedure, no matter how minor, but extremely rare. Spider veins sometimes appear or worsen in the treated area. Sclerotherapy may be needed to improve the appearance of such areas. For most people, local anesthesia does not cause serious problems, and is well tolerated. Some people may feel dizziness, or have minor bruising, bleeding, discomfort, pain, or rarely infection. Very rarely, an allergy to Lidocaine can occur.

Alternative Treatments

Since varicose and spider veins are not life threatening, treatment is not mandatory. Some patients may get adequate symptomatic relief by wearing compression stockings only. Alternative treatments for varicose veins include surgical ligation and stripping, ambulatory phlebectomy, ultrasound guided sclerotherapy, bipolar frequency (heat destruction), or some combination of the above.

Potential Benefits

The potential benefits of the procedure are reduction in the size or closure of the treated varicose veins, and improvement in varicose vein related symptoms. Results to date over the past 5 years have been very promising, with low recurrence rates of varicose veins and an excellent cosmetic result. There is no guarantee that you will receive any medical benefit as a result of EVLT. It is possible that your condition may remain the same or worsen.