Endovenous Laser Ablation (EVLA)
What is EVLA?
Endovenous laser ablation or EVLA is an in-office treatment that uses laser energy, delivered directly inside the vein to eliminate varicosed saphenous veins and other large varicosities . In 1999 – 2000, it was developed by Dr Carlos Bone, Dr Luis Navarro and Dr. Robert Min at the Vein Treatment Centre in Spain and in New York as a replacement for surgery in most patients with large varicose veins.
Under ultrasound guidance and local anesthesia doctors use a catheter to pass a laser fibre inside the vein. The application of laser energy causes the vein to close.
With EVLA, there is no need for hospitalization, general anesthesia or stitches. Following the procedure patients can walk out of the office and resume most normal daily activities with the exception of strenuous exercise and prolonged standing.
The ease and success of this treatment make it a preferred method of therapy for large varicose veins.
What to Expect Before Treatment
You will have an initial consultation and diagnostic testing. During the consultation, Dr. Hill will do a physical examination and Doppler assessment (diagnostic test). Photographs may be taken of your problem area.
Diagnostic testing will help determine the source of your venous problem: the in-office Doppler will allow the doctor to hear the direction of blood flow in your veins. If the exam reveals saphenous vein incompetence (a back flow of blood in the vein) then further diagnostic testing, including color ultrasound imaging will be performed.
What Are the Symptoms of Varicose Veins?
Varicose veins can cause pain, heaviness, swelling, aching, burning, tingling and itching. They often produce leg discomfort or restlessness at night. When severe, they can lead to rashes, ankle discolouration, phlebitis, bleeding, and leg ulcers. Varicose veins can also create a general feeling of fatigue. Their appearance may be cosmetically unappealing and result in lifestyle restrictions (like avoidance of shorts or bathing suits).
EVLA is a 30 to 45 minute procedure that is performed in a medical office under local anesthesia.
Under ultrasound guidance and local anesthesia, a catheter (hollow tube of extremely narrow diameter) is inserted into the vein and a laser fibre is passed through the catheter. Dilute local anesthetic is infiltrated around the vein to provide a cushion of fluid. The fibre and catheter are then slowly withdrawn while laser energy is released along the vein to seal it completely.
Patients experience no pain during lasering of the vein. There can be slight discomfort when the local anesthetic is administered.
No stitches are necessary. You will be given an anti-inflammatory medication to take for 5-7 days. The treated area will be covered with a compression pad and a thigh high support stocking will be placed on your leg. The compression pad can be removed after 3 days. The support stocking should be worn for one minimum of one week.. You may resume normal daily activities, excluding strenuous exercise, immediately.
At 24 hours and at 5-7 days following the procedure, most patients will experience moderate bruising and some lumpiness and soreness in the treated area. All local side effects generally disappear within 1-2 weeks.
To confirm successful treatment, the doctor will perform Doppler and colour duplex ultrasound at 1 week and various monthly intervals after the procedure. Most patients will need sclerotherapy for remaining superficial varicosities and spider veins.
You should not plan on a long plane or auto trip for 3 – 4 weeks after the procedure.
Hundreds of thousands of cases have been performed worldwide. A 95 % success rate with up to five years follow-up has been consistently recorded. Complication rates have been less than 1%, much lower than with traditional surgery.
QUESTIONS AND ANSWERS
Q: How much does EVLA cost?
A: EVLA is not covered by Alberta Health Care. The fee for treating a vein with EVLA is $2900.00 per leg, payable by credit card or direct debit. This fee includes the cost of equipment, disposable sterile materials and staff and physician time.
Q: What are the advantages of EVLA over ligation and stripping surgery?
A: Endovenous laser is a minimally invasive, in-office procedure. It requires only local anesthesia and no stitches. Patients can walk out of the office and quickly return to normal activities.
Q: Is EVLA painful?
A: No. Patients report that there is no pain while the vein is being lasered. There can be slight discomfort when the local anesthetic is administered. There may be some discomfort and tenderness in the treated area for 1 -2 weeks following the procedure.
Q: How long will I be off my feet?
A: Recovery time is minimal. Patients can walk out of the office after the procedure and, in most cases, immediately resume normal daily activities, excluding strenuous exercise and prolonged standing. Long plane or auto trips should be avoided for 3-4 weeks.
Q: What are the typical side effects of EVLA?
A: The common side effects are minor bruising and sometimes a sore, lumpy cord in the treated area, both of which disappear within 1-2 weeks of the procedure.
Q: How long does the procedure take?
A: Although the EVLA procedure itself takes 30 to 45 minutes, the total time required, including before and after treatment is approximately 2 hours.
Q: Will I be able to drive home?
A: You will be given a medication to help you relax during the procedure so you will need someone to drive you home.
Q: Who should not have EVLA?
A: Patients who are pregnant, have had a recent blood clot, have arterial occlusive disease, are in poor general health or on bed rest, are not good candidates for EVLA. Occasionally, a vein may be too small or tortuous to allow passage of the catheter and laser fiber.