Endovenous Laser Treatment (EVLT)

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Endovenous Laser Treatment (EVLT)

EVLT (Endovenous Laser Treatment)

At Surekha Varicose Veins Clinic, vein disorders are treated using minimally invasive treatments such as Endovenous laser treatment (EVLT), Foam Sclerotherapy and CLaCS (Cryo Laser and Cryo Sclerotherapy). Every patient is different and each has findings that require specific treatment for relief of symptoms and correction of vein problems. A single treatment or a combination of the minimally invasive approaches may be necessary.

Varicose veins are traditionally treated by Trendelenburg operation which involves ‘stripping’ of the vein with or without perforator ligation depending on the pathology.

Endovenous laser treatment (EVLT) offers a safe, easier, less morbid and cosmetic alternative to open surgery. Discretion, however, is warranted in case selection.Venous Colour Doppler (ultrasonography of the leg veins) is the gold standard to evaluate varicose veins and is mandatory prior to EVLT.

EVLT Procedure

– Using Ultrasonography (USG) varicose veins are mapped.

– A thin laser fiber is introduced under USG guidance.

– Thermal energy is delivered using the best in class 1470 nm laser leading to collapse and occlusion of the faulty vein. Over the next few weeks, the vein becomes fibrosed and eventually disappears.

– Use of class II compression stockings is recommended for 4 months following EVLT.

FAQs in relation to EVLT

1)Is this procedure done under local anaesthesia?

EVLT can be done both under local anaesthesia and re‐ gional anaesthesia/sedation. The type of anaesthesia used depends on the phlebologist, disease severity (varicose veins) of the patient and patient’s choice. At Surekha Varicose Veins Clinic we prefer to do it under regional anaesthesia/sedation due to following reasons – a)Despite local anaesthesia, some patients experience discomfort. In such cases, the EVLT procedure is ‘hurried up’ resulting in an ‘inadequate job’ , thereby compromising with the final result. However, in regional anaesthesia, the patient does not have any pain and the procedure can be done at ease. As mentioned earlier, regional anaesthesia is routinely given for EVLT procedure in many centres. b)With regional anaesthesia, bilateral EVLT (laser treatment of Varicose Veins in both legs at the same sitting) can be done more comfortably.

2)If we ablate/destroy the vein in EVLT, how does the blood from the leg return to the heart?

The vein which is lasered (ablated/destroyed) is the faulty vein (the valves of which are not functioning properly thereby causing the blood to flow back and cause varicose veins). Following ablation of the ‘faulty’ vein, blood flow is redirected to normally functioning veins that return the blood from the legs to the heart.

3)What are the advantages of EVLT over open surgery of varicose veins?

– Painless – Scarless – Better results – Early resumption of activities (within 48 hours) – No/minimal complications – In patients with bilateral varicose veins, both limbs can be treated at the same time; in surgery, one has to wait 3 months before treating the second limb

4)Are there any complications associated with EVLT?

Few and rare : – Vague pain in the leg – Minor bruising – Numbness along the inner aspect of ankle None of these complaints require separate treatment – they are self limiting and disappear in few days.

5)Does the patient need to take any special care following EVLT?

Yes. The patient is required to wear class 2 graduated compression stockings for 4 months. The stockings are to be worn in morning (within 30 minutes of getting up, after morning rituals of bathing etc). They are to be removed at night time while going to bed. The usage of stockings helps in better and optimal closure of the lasered vein. Apart from this, patient can go about his routine work after 72 hrs (walking/climbing up and down the stairs/travelling). Infact, it is recommended that the patient walks for 30 minutes daily (obviously with the stockings). Treadmill/gym exercises of weight training etc (which increase the intra-abdominal pressure) can be restarted after 4 weeks.

6)If the patient has an ulcer along with varicose veins, can he undergo laser treatment?

How long will it take for the ulcer to heal? Yes, the patient can (and should) undergo laser treatment at the earliest. The time for the ulcer to heal depends on the size of the ulcer. On an average it may take around 4 to 6 weeks. Regular cleaning and dressing of the ulcer has to be done (patient can do it at home) followed by wearing of class 2 stockings.

7)Will the pigmentation disappear completely along with the varicose veins after EVLT?

The pigmentation accompanying varicose veins is irre‐ versible. There is definite improvement; however, the leg will never be returned to its original appearance. Ideally, such patients have to take care of the leg continually (applying moisturiser/coconut oil at least once per day to avoid dryness). Hence, it is important to seek treatment of varicose veins before the complications set in.

8)Does the patient need to use stockings lifelong even after EVLT?

In patients below the age of 60 yrs and especially if they are leading an active lifestyle, it is better they continue usage of class 1 or class 2 stockings. The reason being – varicose veins is a progressive disease of valve degeneration. The faulty vein is treated by laser but other superficial veins (there are many of them in the leg) are prone to varicosities. Usage of stockings will help the calf muscle pump to perform better thereby preventing/delaying the progress of disease.

9)What are the chances of recurrence of varicose veins after laser ablation?

Statistically, the chances of the lasered vein opening up are around 5% at the end of 5 yrs. As mentioned previously, since varicose veins is a progressive disease involving valve degeneration other superficial veins can become varicosed over a period of time. However, even if happens, it is generally not of the same magnitude. Minor varicosities appearing can be dealt with foam sclerotherapy or microphlebectomy (if they are symptomatic). 10)Is EVLT covered under insurance? Yes. All major insurance companies offer mediclaim for varicose veins (after a 2 yr waiting period).