Endovenous Laser Therapy (EVLT) for the Saphenous Vein

Endovenous laser therapy (EVLT) of the saphenous vein, also referred to as endovenous laser ablation, is a minimally invasive, image-guided procedure to treat a varicose saphenous vein in the leg, which is usually the main superficial vein associated with varicose veins.

Endovenous (inside the vein) laser ablation of the saphenous vein involves inserting a catheter (a thin flexible tube) attached with a laser source into the vein through a tiny skin puncture, and treating the entire length of the vein with laser energy, causing ablation (destruction) of the vein wall.  This causes the saphenous vein to close and gradually turn into scar tissue. This treatment of the saphenous vein also aids in regression of visible varicose veins.

Disease Overview

Varicose veins are enlarged veins caused by weak or damaged valves within the veins. They appear twisted and bulging, and are either blue, red, or flesh-colored. They are raised above the surface of the skin and mostly found on the thighs, backs of the calves, and the insides of the legs.

Anatomy of the Saphenous Vein

The saphenous vein, commonly known as the great saphenous vein (GSV), is a large blood vessel running close to the inside surface of the leg from the ankle to the groin.

Blood circulates in the body through a system of blood vessels consisting of arteries and veins. Arteries carry oxygenated blood from the heart to different parts of the body. Veins are the vessels that carry deoxygenated blood from various tissues of the body back to the heart for purification (oxygenation). The leg comprises 2 systems of veins: superficial and deep veins. The great saphenous vein is a superficial vein. Between these 2 systems, there are numerous collateral pathways to allow normal venous blood flow. When the diseased superficial system is treated, the blood gets rerouted into the deep system without affecting blood flow in the leg.

Indications

Endovenous laser therapy is mainly indicated for the treatment of varicosities in the saphenous veins mainly caused by high blood pressure within the vein walls. Factors such as hormonal changes, obesity, lack of physical activity, prolonged standing, and pregnancy can increase the risk of varicose veins.

Preparation

Preprocedure preparation for EVLT of the saphenous vein may involve the following steps:

• A thorough history and physical examination
• Informing your physician about all the medicines or supplements you are taking
• Disclosing any medical conditions you have such as a bleeding disorder or heart disease
• Refraining from blood-thinners, anti-inflammatories, aspirin, or other supplements for a week or two.
• Informing your doctor of any allergies to medications, anesthesia, or latex
• Signing a consent form after the risks and benefits of the procedure have been explained

Procedure

Endovenous laser ablation of the saphenous vein usually takes less than an hour and is done on an out-patient basis. Generally, the procedure will involve the following steps:

• You will lie down on the procedure table in a face-down or face-up position depending on the site of treatment.
• An imaging technique, such as ultrasound, is utilized to guide your doctor throughout the procedure.
• The leg to be treated is administered with a numbing medication to reduce any discomfort.
• Once the skin is numb, a needle is used to make a small puncture hole in the saphenous vein.
• A catheter (thin tube) providing the laser heat source is placed into the affected vein.
• Additional numbing medication may be administered around the vein prior to ablating (destroying) the varicose saphenous vein.
• Using imaging assistance, the catheter is guided to the treatment site, and the laser fiber at the end of the catheter is fired up to heat up the entire length of the vein and seal it closed. This results in stopping blood flow through the vein.
• The saphenous vein eventually shrinks and fades away, eliminating vein bulging at its source and allowing efficient blood circulation through other healthy veins.
• The catheter and laser are removed, and the puncture hole is covered with a small dressing.

Post Procedure care

In general, postoperative care instructions and recovery after endovenous laser therapy will involve the following steps:

• You may experience pain and swelling in the treated leg. Medications are prescribed as needed to address these.
• Application of ice packs over the treatment area is also recommended for 10 minutes at a time for a few days to manage bruising, swelling, or pain.
• You are advised to wear compression stockings for a few days to weeks as this can help prevent blood pooling or clotting, as well as swelling of the leg.
• You are encouraged to walk 10 to 20 minutes about 3 times a day for a couple of weeks, but you should refrain from strenuous activities, lifting heavy weights, jumping, or running during this period.
• Do not stand, sit, or lie down for long periods of time. Keep your legs elevated while sitting.
• You should be able to resume most of your normal activities and return to work in a day or two.
• You must call your healthcare provider if you develop a fever or notice swelling, pain, or other signs of infection at the catheter site.

Benefits

Some of the benefits of endovenous laser therapy over the traditional vein-stripping procedure for varicose saphenous veins include:

• A quicker return to normal activities and work
• An outpatient procedure, and therefore no hospitalization needed
• Minimal pain and fewer complications
• No major incisions are needed; just a small nick on the skin that does not require stitches
• Generally safe and provides an improved cosmetic outcome

Risks and Complications

Endovenous laser therapy for saphenous veins is a relatively safe procedure; however, as with any procedure, some risks and complications may occur, such as the following:

• Bleeding
• Infection
• Pain
• Bruising/swelling
• Blood clots or deep vein thrombosis (DVT)
• Damage to adjacent nerves or vessels
• Skin burning or irritation
• Skin discoloration

Summary

Endovenous laser therapy (EVLT) for saphenous veins is a less invasive procedure than traditional surgery, with a high satisfaction rate. It is a much safer and more effective treatment when compared with traditional vein-stripping procedures for varicose veins.