Endovenous Laser Ablation (EVLA) Treatment
What is Endovenous Laser Ablation?
Endovenous Laser Ablation, often referred to as EVLA or EVLT, is recommended by the National Institute of Health and Care Excellence (NICE) as the Gold Standard treatment option for Varicose Veins.
EVLA was developed in the United States in 2000 and has since revolutionised the treatment of varicose veins with published long-term results demonstrating excellent safety and effectiveness.
EVLA is used to treat the underlying condition causing varicose veins fixing both the cosmetic appearance and symptoms associated with the veins.
It is carried out on an outpatient basis under local anaesthetic and usually takes no more than 1 - 2 hours depending on how many veins need treating.
Most of our patients describe both the EVLA procedure itself, and the recovery period following it, as uncomfortable rather than painful.
So, what does the EVLA procedure involve?
Simple EVLA Description:
Under ultrasound guidance, a laser fibre is inserted through a needle into the vein that needs destroying. Heat is then delivered, and the fibre is slowly pulled along the vein killing it. Once killed the dead veins is then slowly absorbed by your body.
Detailed Description of EVLA Treatment Appointment & Procedure:
Prior to the EVLA procedure an ultrasound scan will have been performed identifying the faulty veins that are the root cause of your varicose veins. See What Causes Varicose Veins?
A full explanation of the treatment options including potential complications and success rates will have been given at your initial consultation. At the start of the appointment, you will be asked to sign to give your consent to the proposed treatment. You will be introduced to the nurse who will be at your side throughout the procedure. The procedure will take place in a small treatment room and music of your choice will be available.
The ultrasound scanner is used as guidance throughout the procedure giving the specialist a live view of your veins at all times.
Firstly, a small bleb of local anaesthetic will be injected and then a needle placed into the vein to be treated. A guidewire (thin wire) will be carefully inserted through the needle into the vein identified as containing the faulty valves. Once this wire is in the correct position, a sheath (thin plastic tube) is then pushed over the wire and fed along the vein. The guidewire is then removed, and the laser fibre is inserted through the catheter and into the vein.
Once the laser fibre is in position, a large volume of local anaesthetic will be administered along the entire length of the vein. The local anaesthetic solution both numbs the legs and ensures that the tissues surrounding the vein being treated are protected from damage. This involves a few needle punctures along the leg.
Finally, once the leg is fully anaesthetised, the laser will be fired up and laser light is delivered to the vein. The light from the laser is very powerful. The energy is absorbed by the tissues in the wall of the vein which are heated to a level sufficient to kill them. The laser fibre will be slowly withdrawn along the veins heating up the vein wall as it goes and destroying it in situ. This will take around 5-10 minutes per vein.
Due to the local anaesthetic given, when the laser is fired you should not be in any significant discomfort however you may feel some slight aching and some patients may notice some odd tastes and smells.
This is repeated on all of the veins which have been identified as causing your varicose veins.
Once the vein has been heated up and destroyed, your body will naturally absorb the dead tissue left behind. This can take several weeks.
An extremely common question is: “If the vein has been destroyed, what happens to the blood that used to flow in it?” The veins that have been treated were functioning properly anyway and so the blood is simply diverted to your healthy veins which are functioning normally.
Once the procedure has finished, a compression stocking will be put on and after a cup of tea you are allowed to leave the clinic, take a fifteen-minute walk and get back to normal activities.
You will have to keep your stocking on for 1 week in total. Over the next few weeks you may experience some tautness as the vein shrinks. You may also get some bruising, but this is unlikely to be severe.
The vast majority of patients experience no or little pain and can get back to normal activities straight away. A small minority experience severe pain and have to take a few days off work. This is most likely a week following the procedure rather than straight away.
If you were experiencing symptoms associated with your varicose veins (such as aching, throbbing, itching etc.) these should begin to resolve quite quickly following the EVLA treatment. Patients usually note that their symptoms have fully resolved when they attend for their first follow-up.
We strongly advise that you attend for a follow-up approximately 6 -8 weeks following EVLA treatment. The vast majority of patients will require some form of treatment at follow-up and it is also important that we check that the EVLA treatment has successfully fixed your underling vein problems as intended.
Do not be surprised if the varicose veins are still there at this stage. They are usually reduced in size but rarely will have entirely gone and not infrequently look just as large as they did before treatment. Don’t panic and think the treatment has not worked!
Although EVLA will have fixed the underlying problem, most patients will require foam sclerotherapy or avulsions/phlebectomies in order to treat the actual varicosities.
For further information regarding follow-up treatment see: Foam Sclerotherapy and Avulsions/ Phlebectomies. Following any treatment with us support stockings must be worn for a week.
Frequently Asked Questions regarding EVLA:
Can EVLA be used to treat twisty veins?
As the instruments that we used to perform EVLA are thin and flexible, it can be used to treat twisty veins. Some surgeons in other clinics will often tell patients that their veins are too twisty and they will need surgery. This is either because they are using radiofrequency, which is a much more ridged instrument, or because they are inexperienced and incapable of negotiating the bends and twisty veins.
Can EVLA be used to treat Perforators?
The first line treatment for perforators is EVLA. If EVLA is not possible then perforators can be treated using Foam Sclerotherapy or occasionally Open Ligation may be required. We treat perforator veins at the same time as the other veins being treated with EVLA and hence there is no additional charge for these as our EVLA prices are fixed per leg, irrelevant of the number or type of veins needing EVLA.
When is EVLA not required?
If the duplex ultrasound does not reveal any significant valve problems in your feeder veins, or the veins are very small, EVLA treatment may not be required. If your veins are too small for laser then it is likely that foam sclerotherapy will be performed instead.
What are the alternative treatment options to fix the underlying cause of varicose veins if I don’t want to undergo EVLA?
ClariVein, RF Ablation, Sapheon Superglue.
What are the potential complications associated with EVLA?
Very few complications have been described. Potential problems include deep vein thrombosis, deep vein trauma, skin burns, nerve injuries and laser eye injuries. In practice these are all very rare or have never yet been reported. See our Risks page for more details.
A problem common to all interventional radiological procedures is that occasionally it proves impossible to get access to the vein and the procedure needs to be cancelled and rescheduled. This is a nuisance but no lasting damage will have been done. Due to our experience, this is very unlikely in our hands and as such you would not be charged for the repeat procedure. (Clinics with little experience are quite likely to have to abandon the procedure and bring you back a second time)