Endovenous laser therapy for major saphenous reflux has been in use since about 2000-2001.
This is predominantly used to treat large Great and Small saphenous veins, previously treated by surgical ligation and stripping in hospital under general anaesthetic. Under local anaesthetic a small skin puncture is made with the laser probe thereafter being passed up the vein under ultrasound guidance. The vein is then surrounded by a column of anaesthetic. The laser fibre is activated and slowly withdrawn destroying the vein.
If necessary Ambulatory Phlebectomy and Ultrasound Guided Sclerotherapy would be performed in the same session. If there are residual incompetent varicosities that require further treatment, this will usually be performed about 2 weeks later.
What are the advantages and disadvantages for EVLA?
ELVA is very effective in treating larger veins, especially those larger than 5mm. This is usually performed on veins such as the Great and Small Saphenous Veins and the Anterior Accessory Vein. This does not require admission to hospital or anaesthesia. There is usually no need to take time off work and one is able to continue with ones day to day activities. The Small Saphenous Vein often responds better to EVLA than to Sclerotherapy. The cost for Laser treatment is often greater than that for Sclerotherapy alone.
What should you do before EVLA?
Do not apply moisturiser to your legs on the day of treatment. Wear loose fitting clothing and sandals or loose shoes to allow for the thickness of the stockings.
What happens during EVLA?
You will lie down on a treatment bed and will be given a subcutaneous injection of the anticoagulant drug Clexane. You will be draped as per a surgical procedure. Just before the procedure, a Sonographer performs a limited scan of the leg similar to the initial screening scan to familiarise us with the veins. The vein is punctured through an anaesthetised site around the knee for the great saphenous vein and the calf for the small saphenous vein. A wire is passed up the vein, a 20-45cm long fine tube is passed over the wire, the wire withdrawn and the laser probe introduced through the tube. Local anaesthetic is infiltrated around the vein at several levels directed by ultrasound using extremely fine needles.
The laser tip is precisely positioned just below the end of the vein at the groin for the great saphenous vein and the knee for the small saphenous vein using ultrasound guidance. The probe is activated and slowly withdrawn destroying the vein. The procedure involves minimal discomfort. Often thereafter Ultrasound Guided Sclerotherapy and/or Ambulatory Phlebectomy will be performed to treat the remainder of the diseased veins in the leg.
After completion a bandage and stocking will be applied to each treated leg.
What should you do after EVLA?
You will be asked to go for a 30-40 minute walk immediately after treatment. It is essential that you arrange for someone to drive you home. Walk or keep the leg elevated as much as possible for the first 24 hours and walk for 30-40 minutes each day for 2 weeks. Maintain normal daytime activities and avoid standing still for long periods.
Avoid strenuous physical activity such as aerobics for 48 hours after treatment since this increases the risk of blood flow returning into the treated veins.
You are required to avoid any flights of 2-4 hours duration for 2 weeks and any flights of greater than 4 hours duration for 6 weeks after treatment. If travel is unavoidable, then the flight should be covered by subcutaneous Clexane for anticoagulation given before departure and daily for 5 days after arrival.
A bandage and stockings are worn continuously for 48 hours. Stockings are then worn through the day, removing them at night and replacing them in the morning after the shower for another 12 days. It is routine practice to perform a check ultrasound scan 1 week after treatment to ensure that the treated vein is occluded and to exclude the very small risk of DVT. Some patients will require follow up treatment of residual varicosities by Ultrasound guided Sclerotherapy, which would be performed about 2-4 weeks later.
What can you expect following EVLA?
The following features are expected:
What are the possible complications from EVLA?
Adverse reactions for EVLA do not differ much from those for UGS. Complications can occur even with perfect technique.
These include:
