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Endovenous Laser Ablation (EVLA)

Endovenous laser ablation, often referred to as EVLA (or EVLT), is the gold-standard treatment for varicose veins – as recommended by the National Institute of Health and Care Excellence (NICE).

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EVLA Laser machine
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What is EVLA?

Endovenous Laser Ablation (EVLA) is used to treat the underlying condition that causes varicose veins. It restores healthy blood flow to the legs, thus fixing both the cosmetic appearance and the symptoms associated with the veins.

It is a walk-in, walk-out procedure carried out on an outpatient basis, under local anaesthetic. It usually takes no more than 1 to 2 hours; depending on how many veins need treating. Most patients describe both the EVLA procedure itself, and the recovery period following it, as uncomfortable rather than painful.

 

History of EVLA

EVLA was developed over 20 years ago in the United States and has published long-term results demonstrating excellent safety and effectiveness. It revolutionised the treatment of varicose veins and patients should no longer be offered surgical stripping under general anaesthetic as the first line treatment.

 

What does the EVLA procedure involve?

Under ultrasound guidance, a laser fibre is inserted into the vein that needs destroying. Heat is then delivered, and the laser fibre is slowly pulled along the length of the vein, killing the vein in the process. The dead vein is then slowly absorbed by your body and healthy blood flood is restored to your legs.

A detailed description of EVLA treatment

Pre-procedure

Prior to the EVLA procedure, an ultrasound scan will have been performed, identifying the faulty veins that are the root causes of your varicose veins.

A full explanation of the treatment options; including potential complications and success rates, will have been given at your initial consultation. Prior to proceeding with the proposed treatment, it is important we check that you understand all the information provided to you. You will then be asked to sign the required documentation.

You will also 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 procedure

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 and into the vein that contains 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 in question 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 delivering laser light 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 up to a level sufficient to kill them. The laser fibre will be slowly withdrawn along the vein, thus heating up the vein wall as it goes and destroying it in situ. This will take around 5 to 10 minutes per vein.

Due to the local anaesthetic given, you should not be in any significant discomfort when the vein is being lasered. You may however feel some slight aching, and some patients may notice some odd tastes and smells. This is repeated on all of the veins that have been identified as causing your varicose veins.

Unfortunately, we do have some patients (less than 5%) who find the injection of the local anaesthetic and lasering painful. Most patients however come out and say things to the effects of, “It wasn’t painful as such – just a bit uncomfortable,” and commonly describe the sensation as “weird”. There’s no rhyme nor reason why a few patients find it painful and others not, but our advice is to expect the worst and then the vast majority of patients are pleasantly surprised… “Better than a visit to the dentist!”

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 we are asked is:
“If the vein has been destroyed, what happens to the blood that used to flow in it?”
The veins which we treated were not functioning properly anyway, and so the blood is simply diverted to your healthy veins which are functioning normally.

 

Post-procedure

Once the procedure has finished, the nurse will help you put on a compression stocking/s. They’ll talk you through how to wear these and any post-treatment symptoms to look out for.

You’ll be asked to take a 10 minute walk following the appointment prior to making your way home. It is important to note, you are unable to drive on the day of treatment, but you are fine to drive the day after. You cannot fly long haul (over 4 hours) for 4 weeks post procedure but short haul flights are fine.

 

Recovery

You will need to keep your stocking/s on for 1 week in total. Over the next few weeks, you may experience some tautness as the vein shrinks. You are highly likely to experience some degree of bruising of the leg; for most patients this is mild but it can be quite severe (don’t be alarmed if your leg is a lovely shade of purple for a week or so).

The vast majority of patients experience little to no pain, and can get back to normal activities* straight away. A small minority experience severe pain resulting in them having to take a few days off work. If patients do experience pain, disconcertingly, it is usually around 5 -7 days post treatment rather than straight away. This is when the treated veins start to be absorbed by the body and patients will often describe it as a tightening sensation.

If you were experiencing symptoms associated with your varicose veins (such as aching, throbbing, itching, etc.), these should begin to resolve quickly following the EVLA treatment. Patients usually note that their symptoms have fully resolved when they attend for their first follow-up appointment.

*You will be wearing a support stocking for a week and so you’re unable to go swimming and we discourage horse riding and heavy weight-lifting. Your consultant will advise if there is anything else you should avoid.

 

EVLA follow-up

We strongly advise that you attend for a follow-up approximately 6 to 8 weeks following your 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 underlying 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 they have gone entirely. Sometimes, they will look just as large as they did before treatment, but don’t panic this does not indicate the treatment has failed. Although EVLA will have fixed the underlying problem, most patients will require foam sclerotherapy or avulsions/phlebectomies in order to treat the actual varicosities.

Following any treatment with us, support stockings must be worn for a full week.

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