Endovenous Laser Ablation Therapy (EVLA) is a non-invasive or keyhole method of treating painful, swollen, or unsightly varicose veins without surgery. Instead of cutting, tying and removing the abnormal veins, they are heated from the inside using laser energy. Performed with a local anaesthetic, EVLA is a minimally invasive procedure that uses laser heat to destroy varicose veins.
The laser energy heats the vein to a temperature at which the vein closes and is cauterised. All the living cells that make up the vein wall are sterilised and the vein cannot recover, regrow and rejoin. Over the course of a few weeks the body then naturally absorbs the vein and when the treated area is examined with ultrasound a few months after treatment, the abnormal vein has almost completely disappeared, there is just a small amount of scar tissue.
EVLA achieves a better outcome than surgical tying and stripping without the need for major surgical cuts and painful removal under general anaesthetic. EVLA can be carried out in a simple treatment room rather than an operating theatre. In addition, after EVLA, unlike surgical stripping there are no “raw ends of living vein” that can regrow or rejoin. The risk of veins coming back after EVLA is much lower than with surgery or foam.
EVLA is the preferred surgical option for varicose veins by the National Institute for Health and Care Excellence (NICE) as opposed to invasive vein stripping surgery or Foam.
Most patients have varicose veins that are suitable for EVLA as the technique is versatile and can treat both primary and recurrent veins. It does not however treat all the superficial surface veins, and these are normally either injected or removed at the same time as a combination procedure.
However, not all patients with varicose veins are suitable for this treatment. EVLA is not recommended for people who are in poor general health, unable to walk, have a clotting disorder, or are pregnant. A pre-procedure ultrasound scan may show that your varicose veins are not suitable for EVLT if it finds excessive twisting or inflammation of your vein. Your surgeon will advise you about alternative treatments if EVLA is not suitable for you.
The whole procedure normally takes 1-2 hours depending on how extensive your veins are and if you are having one or two legs treated.
Endovenous means inside the vein, so your consultant will insert the fine laser fibre into the vein. A small amount of local anaesthetic is injected into the skin and once the skin is numb, a needle is inserted into the vein.
Through this needle, a fine laser fibre is inserted into the vein to be treated. These steps in the procedure are guided by ultrasound. Once the laser fibre is in the correct position, as confirmed by ultrasound, the vein is numbed by a series of local anaesthetic injections with a fine needle.
You will be asked to put on laser safety goggles as a precaution. The laser is then activated and the laser fibre is gently withdrawn along the length to be treated, the vein is sealed, cauterised and sterilised. You should not feel the laser treatment at all.
If you are having both legs treated the process is repeated on the other leg. The laser is removed and the needle puncture covered with a small dressing.
The costs of endovenous laser surgery vary from patient to patient. They will depend on the number of veins that need treating and your Ramsay hospital of choice.
You will receive a formal quotation price for your EVLT after your consultation with one of our experienced vascular surgeons. This formal quote will be valid for 60 days.
The costs of your endovenous laser therapy may be covered by medical insurance. Health insurance typically does not cover this procedure if it is for cosmetic reasons. However, if it is recommended for medical reasons such as your varicose veins are causing you pain and discomfort, EVLT may be covered by your insurance. We advise you get written confirmation from your insurance provider before your vein treatment commences.
If you are paying for yourself, we offer a variety of payment options including interest-free finance.
Most people recover quickly from endovenous laser treatment.
After treatment, you will have compression bandages on for five to seven days. You will then wear a compression stocking which you should keep on for a further one to two weeks.
You can expect bruising and aching or pain in the treated area. This usually resolves after a few days but may be longer for some patients. Painkillers can help.
Typically, you can get back to your normal activities within a week or two.
Vigorous activity and hot baths should be avoided for the first 2 weeks. Also, avoid flying and excessively long journeys for the first four-six weeks.
We will arrange a follow-up appointment after your treatment to determine the success of your treatment and to discuss if any additional top up treatment might be needed.
Whilst Laser is almost universally recognised as the “Gold Standard” treatment, the best results can be achieved when laser treatment is performed in combination with other treatments such as phlebectomy or foam. Foam is rarely used on its own as a treatment for varicose veins as it is not suitbale for larger veins (>6mm) and has a higher complication and recurrence rates compared with laser.
Whilst EVLA effectively closes the main refluxing veins, it cannot treat the very superficial varicose veins under the skin. It is therefore normal to have Phlebectomy and/or foam sclerotherapy performed in addition.
After your leg is treated, often a large, padded bandage is applied and you will be given a stocking to take home along with aftercare advice.
Patients are normally advised to wear the stockings for at least one week after treatment. Depending on your veins and surgeons’ opinion you may be able to remove the stocking at night.
The recovery after EVLA is very rapid and most people can get back to work within a few days to a week with very few restrictions. People may return to work earlier if they feel comfortable.
If the varicose veins are very extensive and if phlebectomy is performed at the same time, it may be appropriate to arrange a few more days off work.
We advise that you start driving when you feel confident to perform an emergency stop.
Avoid activities that make your legs hot, such as vigorous aerobic exercise or saunas.
Walking is encouraged but try to avoid excessive exercise for about 2 weeks. Listen to your body and rest when needed.
Most people experience a tightening sensation along the length of the treated vein, and some get pain in that area around 5 days later, but this is usually mild.
Normal anti-inflammatory drugs like Ibuprofen are normally sufficient to relieve it.
EVLA is one of the safest treatments available for varicose veins, serious complications are thankfully extremely rare but include:
Thrombophlebitis: EVLA works by heating the wall of the vein and an inevitable and deliberate response to the heat is an inflammation of the vein wall. You may feel the vein that has been treated become hard and tender. Varicose veins that feed from the treated vein may also become hard and lumpy as part of the healing process. The phlebitis will resolve over a few weeks.
Nerve damage: As nerves can lie alongside the veins these may also become damaged by the heat or by Phlebectomies and a few patients notice small patches of numbness on their skin. These usually resolve over a few months.
Burns: Although it is possible to burn the skin with the laser in practice this is very rare indeed.
DVT: A DVT is a blood clot in the deep veins in the leg. It is a recognised complication of surgery and can be dangerous if the clot breaks away and travels to the lungs. The risk of getting a DVT after EVLA is very low but has been reported, the risk is less than 1 in 200 for most people.
Endovenous laser ablation (EVLA), or Endovenous laser therapy (EVLT) is an outpatient procedure with minimal downtime that uses laser heat to quickly remove varicose veins.
At Ramsay, we regularly perform endovenous laser therapy to safely and effectively remove unsightly or painful varicose veins. This means that our vascular surgeons are highly experienced in EVLA, as well as other vein treatments.
Unfortunately, varicose vein removal for cosmetic reasons is rarely available on the NHS. For those in discomfort, the NHS has waiting lists and various qualifying grading criteria. At your local Ramsay hospital, we swiftly treat all patients who want to remove their varicose veins. Booking is simple and doesn’t require a GP referral.
Treatment is fast and effective so you can get back to your daily routine within a matter of days.
Rob Windhaber is a vascular surgeon who specialises in the treatment of varicose veins, leg thread veins, facial thread veins and their related conditions. He has over 15 years experience in treating these conditions using minimally invasive techniques.
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