EVLT Laser Surgery for Varicose Veins
What are the latest treatments for varicose veins?
There are some recent advances in varicose vein surgery involving the use of new techniques which are ‘minimally invasive’ – that means that they aim to achieve the same result as the ‘high tie and strip’ without making large cuts in the leg and with less bruising and post-operative pain.
ENDOVENOUS LASER TREATMENT (EVLT)
EVLT is a minimally invasive way of treating varicose veins. Instead of making a cut in the groin and stripping the vein from the thigh, the surgeon uses a fine laser fibre to zap the vein from the inside. This causes the vein to close and eventually shrivel up as the body absorbs it naturally.
- The thigh vein is accessed though a tiny incision (2mm) just above the knee. The laser fibre is passed into the vein and positioned in the correct place with guidance from an ultrasound probe.
- Local anaesthetic is injected around the vein before activation of the laser. When the laser is turned on, the fibre is slowly withdrawn down the leg.
- As the fibre is withdrawn, the laser energy burns the inside of the vein, sealing it from the inside.
- A compression bandage is then applied to the leg and replaced with an elastic stocking before the patient goes home.
- EVLT is less painful than open surgery and people return to work faster than after open surgery. There is less bruising and there are no incisions in the top of the leg.
- EVLT can also be done under local anaesthetic without the patient being put to sleep, or the operation can be done under general anaesthetic where the patient is put to sleep for a short period of time.
Having the operation:
- Under local anaesthetic you will need to have a few injections during the operation. We use a very tiny needle but it is still a little bit uncomfortable – it is a bit like going to the dentist. If you are scared of having a local anaesthetic, you can have a general anaesthetic instead.
- The operation takes about 30 – 40 minutes. Even if the patient decides to have a general anaesthetic, the vast majority of patients go home on the same day as the treatment with bandages on the legs and painkillers.
- Some patients have almost no pain after surgery but most patients find they need to take painkillers for a few days. Sometimes patients can feel the treated vein as a tender cord in the thigh after the operation, but this feeling goes away within a couple of weeks.
Will I be suitable for EVLT?
- Generally speaking about 90% of veins patients are suitable for EVLT. Patients who are not suitable for EVLT can be treated by one of the other methods of vein surgery. The commonest reasons why people are not suitable are:
- The vein is very tortuous or very small
- The vein has suffered from previous ‘thrombophlebitis’
- The vein is very large in which case it might not seal after EVLT and might be better treated with a high tie and strip.
Complications of EVLT
- The commonest complication of EVLT is a vein irritation that lasts a couple of weeks, but very few patients get this. The main serious complication is the risk of getting a deep vein thrombosis which is a clot in the deep veins of the leg. Theoretically anyone can get a DVT after any surgical procedure. However, the risk of DVT after EVLT is very low (less than 1 in 1000).
After the operation
- The bandages are worn for 5 days after surgery then soaked off in the bath and replaced by a compression stocking which is then worn for 2 weeks.
- Two types of painkiller are usually given to people after surgery – Voltarol and Codydramol. We advise patients to take them together and regularly for the first few days. They are well tolerated although Voltarol should not be taken by patients with a history of stomach ulceration.
- We also find that a lot of people say that Arnica taken as either tablets or cream can help to reduce the bruising after surgery.
Getting better from surgery:
- Latest studies suggest the average time off work is 3 days after EVLT – compared with 12 days after open varicose vein surgery.
- The majority of people will be OK to drive after 3 – 4 days but it is important to check with your car insurance company that they will cover you after an operation.
- Generally speaking it is advisable to avoid heavy exercise for a week or two while the healing process takes place. You are unlikely to harm yourself if you exercise sooner, but it might hurt a bit! Long haul flights should probably be avoided for 3 – 4 weeks after surgery.
- At 6 weeks after surgery if there are any small veins left over in the calf, they can be removed under local anaesthetic by making some tiny (2 millimetre) nicks in the skin, or by injecting them with a chemical ( this is called injection sclerotherapy)
- For lots more information about EVLT laser treatment, including answers to the questions that patients commonly ask, please click on this link: www.londonlaserveins.co.uk.