EVLT Procedure

There are two types of veins in your leg – the superficial and deep venous system. Blood flows from the superficial to the deep system and then to the heart. There are valves connecting the superficial and deep veins. In patients with varicose veins, these valves and perforators are damaged, causing blood to flow in the reverse direction from the deep to the superficial venous system. Therefore blood starts pooling in your legs.

This causes symptoms like pain, heaviness, discolouration or in severe cases venous ulceration. Earlier, the treatment of Varicose Veins involved stripping or ligation and surgical excision and removal of these superficial veins. However, open surgical procedures had its own set of complications with a longer recovery time and a much higher rate of recurrence. Therefore currently the gold standard of treatment of Varicose Veins is laser ablation.

The principle of EVLT involves burning of these superficial veins i.e the great and short saphenous vein and foam sclerotherapy of the superficial varicosities. Unlike surgical open stripping, in EVLT, using heat generated through the laser fibre, the veins are ablated. Over a period of time these veins becomes fibrous, thin and cord-like and serve no function. This causes the resolution of symptoms since there is no longer any pooling of blood. 

No, all Varicose Veins do not require treatment. However, they do require monitoring and management. Only symptomatic Varicose Veins that causes symptoms like pain, heaviness, pigmentation or venus ulceration require treatment. Early grade Varicose Veins can also be controlled with compression stockings only.

Only severe varicose veins and those causing symptoms require EVLT. Before undergoing EVLT, your doctor may advise you for a trial of conservative management in the form of stockings only. Also, before undergoing EVLT it is also important to rule out secondary Varicose Veins i.e other causes of venous insufficiency like chronic deep venous insufficiency, may thurner syndrome, pulmonary hypertension and/or other cardiac causes of venous insufficiency.

• EVLT is a daycare procedure. It is safe and does not require any prolonged immobilisation after the procedure.
• It is generally performed under local anaesthesia with some sedation. Sometimes, spinal anesthesia may be given.
• It generally takes around one hour for EVLT of one lower limb.
• Your leg shall be shaved and cleaned. Following this, a small incision will be taken at the level of the ankle.
• A special tube called a sheath will be placed inside the vein which needs to be ablated.
• Following this, the special laser fibre will be inserted inside the vein. A solution will be infliltrated around the vein called tumescent anesthesia.
This will be given to compress the vein and bring it in contact with the Fibre.
• Then, using heat the vein will be ablated throughout its course.
• After the procedure, you will be advised to wear class II compression stockings for 6 months on a daily basis. These stockings will be have to be worn throughout the day and can be removed at night.
• Medication in the form of antibiotics and anti-inflammatories will be given for two weeks. Some local ice pack and ointment will also be given. You will be asked to follow up after two weeks and then at three months.

Latest advances in Endovenous Laser Ablation

Earlier, the 1470 nm laser Fibre was available. However, the latest 1940 nm laser Fiber is now available. Post procedure pain, bruising and numbness is much lesser with the 1940 nm laser Fiber as compared to the 1470 nm laser.

Which doctor will be performing EVLT?

Image guided procedures require specialists doctors called Interventional radiologists (IR). These are specially trained medical professionals who performs image guided vascular procedures.

Closure rate of the GSV or the SSV using laser is around 96 to 97%. In 3% of cases, the GSV once closed may open up again. This most likely happens either due to in adequate ablation or technique or if stockings are not adequately worn post procedure.

For foam sclerotherapy the chances of reopening of the superficial Varicosities is between 27 to 30%. It is important to note that the superficial Varicosities are only of cosmetic concern. They do not have any medical significance. It is the closure of the main venous channel i.e. the GSV and the SSV closure by laser that is important.

About Foam Sclerotherapy

EVLT involves closing the main long venous channel called the GSV or  the SSV. However for the superficial tortuous Venus Varicosities,  a special injection may have to be given to close them. This procedure is done using a special drug called sodium tetradacyl sulphate or STS. The procedure of closing the superficial Varicosisties using the form of STS is called foam sclerotherapy.

EVLT is a daycare procedure. All routine activities can be continued from the next day. Some amount of pain and bruising is expected for around 3 to 4 weeks. However with adequate medication, this pain and bruising is also manageable. All routine activities can be continued within a day or two after the procedure. No bed rest is required after the procedure.

Potential Complications Endovenous Laser Ablation Procedure?

EVLT is an extremely safe procedure if done in the correct patient and in the correct manner. After the procedure mild bruising and pain is expected for around 3 to 4 weeks. However, this usually settles with medication and ice packs. One of an extremely rare but dreaded Complication of EVLT is deep vein thrombosis. However when done under the complete guidance of ultrasound by a well-trained interventional radiologist, the chances of DVT are almost negligible.

Class II Thigh High compression stockings are to be worn after the procedure. They do not have to be removed for the first 48 hours. After that, they need to be worn on a daily basis and removed at night for the next six months. The purpose of stockings is to give external compression so that the veins which have been burnt and ablated remain closed and do not open up again. After six months, you will be asked to shift to below knee stockings or support socks as a preventive measure.