Endovenous Laser Treatment (EVLT)

Why Endovenous Laser Treatment (EVLT) is better than conventional surgery?


Endovenous LASER Treatment Conventional surgical procedure for Varicose veins is known as LIGATION & STRIPPING of varicose veins. It involves general or spinal anesthesia, & there are multiple incisions along the course of vein through which segments of varicose vein are pulled out with the help of a metallic stripper. The incisions are sutured later on. Compared to this EVLT is a fairly non-invasive procedure as it can be done under local anesthesia through a small needle puncture only which doesn't require any suturing. It can be done as a OPD procedure or a day-care procedure. Patients can return to work very early.
With the advent of latest technology in Medical Lasers, treatment of Varicose Veins has become much easier with better results as compared to conventional methods. After thorough investigations & assessment of superficial & deep veins by careful clinical examination as well as Duplex Colour Doppler study, the procedure is planned. In single sitting more than one diseased vein can be treated.

EVLT: Under appropriate anesthesia the vein to be treated is punctured by a small needle under ultrasound guidance. A guide-wire is passed through the needle over which a venous catheter is passed upto the Sapheno-femoral junction in case of Long Saphenous vein & up-to the Sapheno-Popoiteal junction in case of Short Saphenous vein. A flexible 400 micron bare fibre is passed through the catheter & positioned about 1.5 cm below the valve. Then under USG guidance Normal saline is injected around the vein so as to create a heat-sink. Then the 810 nm Diomed Diode LASER is set at 10 watts of power. LASER is activated & the fiber is slowly withdrawn at a specific speed so as to give adequate energy to ablate the inner lining of the diseased vein. Entire procedure takes about 30 to 40 minutes & can be completed through a single needle puncture which leaves no scar.

AFTER TREATMENT: Patient starts walking immediately if done under local anaesthesia & can resume daily activities in a day or two. Prolonged standing or sitting without moving the legs should be avoided for about one month. Sitting cross legged should be avoided for 1 month. Daily about 2 kilometer walking & light exercises should be undertaken. Any kind of massage or squeezing of legs should be avoided. Properly fitting custom made graded pressure venous stockings should be used throughout the day. Legs should be slightly elevated while sleeping.

POSTOPERATIVE COURSE: One should expect some bruising along the treated vein during first few days of EVLT . There is an area of numbness on the inside of ankle which may last from few days up to 3 months. From about 48 hours onwards, the treated area on the inside of thigh & leg becomes slightly swollen & inflamed. Patient starts feeling a pulling sensation along the vein, as the vein starts shrinking lengthwise after a successful treatment. If proper postoperative leg exercises are continued then there is almost total recovery of these symptoms.

RESULTS: Overall success rate of ENDOVENOUS LASER TREATMENT at best of centers in the world is about 92%.

COMPLICATIONS: EVLT is a very safe procedure with very minimal complication rate. As mentioned above inflammation along the course of treated vein & numbness at the site of puncture are the common complications which are self limiting & respond well to medicines.