Endovenous Laser Ablation [EVLA] of Varicose Veins
Most patients who are seen by Mr Tsavellas are offered endovenous laser ablation (EVLA*) rather than surgical stripping of their veins. Depending on the extent of veins present and the patients preference, this may be carried out on an outpatient basis under local anaesthetic or daycase basis under general anaesthesia. Under ultrasound guidance, a thin fibre-optic probe is inserted through a tiny entry point, usually near the knee. Laser energy is delivered in short pulses to seal the faulty vein so that blood cannot flow through it. The lasering is not painful but there is some discomfort from the local anaesthetic injections. The procedure takes about 50 minutes per leg.
You may require some additional treatment for management of any residual smaller varicosities in the lower leg – usually through very small stab incisions called avulsions. This can be undertaken at the same time or later, depending on the pattern of veins and type of anaesthetic used. After treatment, the blood in the faulty veins will be diverted to the many normal veins in the leg. Walking immediately after the procedure is encouraged.
EVLA has a very good safety record with significant complications being very rare. It is over 95% successful at obliterating the cause of the varicosities and 90% of patients are happy with the results. Recurrence of varicosities after EVLA is uncommon; this occurs in around 5% of cases. Side-effects from EVLA are minor but do expect bruising, with some discomfort most apparent at 5 days and a tight feeling as the vein contracts. Serious complications are very rare but could include DVT (deep vein thrombosis), skin burns, nerve damage causing patches of skin numbness, leg swelling and arterial damage. You will have to wear compression stockings for two weeks after the treatment and we advise that you do not fly for at least three weeks but otherwise you can get on with your life as normal with minimal time off work.
*EVLA may not always be a suitable treatment; however this would not be known until after your first consultation.
Liquid sclerotherapy (injection treatment) is still the treatment of choice for thread veins but for larger veins the results of just injecting liquids are not good enough. Some doctors even use foam as a substitute for major surgical stripping but EVLA is more effective and durable for larger veins.