Endovenous Laser Ablation – EVLA

At Phoenix Wellness Clinic, we introduce the new treatment of varicose veins using the latest laser technology ” NEO-LASER“.

With laser wavelength of 1470 nm, “NEO-LASER” is much better tolerated compare to older devices with wavelength of 1064 nm, therefore causing less discomfort.

How do I know if my varicose veins are suitable for laser treatment?

Not all varicose veins are suitable for EVLA. It is best suited to varicose veins greater than 6mm in diameter that are straight and not close to the skin surface. Ultrasound is used prior to the procedure to map the leg veins to determine the direction of venous flow and the extent of the  problem. The map is our work plan and a reference point for the future. Together with the initial consultation, the mapping will determine if your veins are suitable for EVLA. Saphenous veins are the main superficial veins of the legs. It is these veins that are most suitable for EVLA. Other visible, large varicose veins may not be suitable for EVLA because they are too close to the skin surface (risking heat damage to the skin) or too tortuous to allow for the passing of the laser fibre. These veins are injected immediately following the lasering. They frequently require some tidy-up injecting several weeks later. EVLA has a more powerful but controlled effect on the vein wall than can be achieved by ultrasound guided sclerotherapy (UGS). Consequently the success rate is higher with EVLA for large veins.

What’s involved with the procedure?

The procedure is performed under local anaesthetic. The local anaesthetic is high volume and low concentration and has several benefits. Firstly, the vein is totally numb resulting in no pain during lasering. Secondly, the cuff of anaesthetic surrounding the vein causes the vein to contract onto the laser fibre resulting in the vein being in close contact with the fibre. Thirdly, the cuff of local anaesthetic absorbs and dissipates the residual heat from lasering, preventing heat damage to tissues surrounding the treated vein. A small 3mm skin incision is made to place the laser fibre inside the vein. This tiny incision does not require a stitch. Under ultrasound guidance the laser fibre is carefully inserted to where treatment begins. The vein is then lasered as the fibre is slowly withdrawn. Once the treatment is completed a compression stocking will be fitted on the treated leg. This needs to be worn for 2 weeks.

How long does the EVLA take? Is there any down time?

The procedure takes about 60-90 minutes and you can return to normal activities straight away. You are able to drive after the procedure.

I’m scared of needles… what can I do?

While there is some discomfort associated with EVLA most patients tolerate the procedure very well.

What happens after EVLA? How often do I come back for check – ups?

The vein does not immediately shrink to a small, permanently sealed structure. This process takes months and is monitored by ultrasound examinations at follow-up appointments. Hence the review appointments are important to ensure a good long term result. The vein is checked by ultrasound at three weeks, two months and six months. In the unlikely event the vein has not remained closed it will have diminished significantly in size and it is subsequently closed off using ultrasound guided sclerotherapy. It takes from three to six months (depending on vein size) to fibrose completely. This is determined by the ultrasound appearance. Good cosmetic improvement occurs well before this.

What are the side effects of treatment?

Bruising – this is the most common side effect. It is harmless and resolves in approximately 2 weeks.

Pain – after the procedure. There may be some discomfort in the treated leg although rarely is it painful. Anti – inflammatory tablets are helpful for the first

5 days after the treatment. Trapped blood – can form tender lumps along the course of treated varicose veins. It is harmless but may be tender, red and angry. This may occur one to twelve weeks after the procedure. Blood can be drained from these lumps which will hasten the resolution of any tenderness and help prevent pigmentation of the skin. Blood trapping is most common in large varicose veins.

Infection – this is very rare after EVLA but if you get redness, pain, swelling and a fever you should contact us as soon as possible.

Deep vein thrombosis (DVT) – occurs in less than 1 in 600 patients. DVT is prevented by walking daily and wearing the compression stocking.