EVLA

EVLA stands for Endovenous Laser Ablation, as all the various types of laser ablation are essentially the same. Endovenous laser ablation goes under several proprietary names e.g. EVLT, ELVes, VeinSeal, depending on the manufacturer of the laser. 

About the Procedure of EVLA

An ultrasound scan is performed and the veins to be treated are marked with a pen. You lie on a couch and your leg is cleaned and covered with drapes. Depending on which veins are to be treated, you may be on your back or your front. All these steps are guided by ultrasound scanning.

 

Endovenous means inside the vein, so the next thing the doctor has to do is to get inside your vein. A small amount of local anesthetic is injected into the skin over the vein and a needle inserted into it. A wire is passed through the needle and up the vein. The needle is removed and a catheter (thin plastic tubing) is passed over the wire, up to the vein and the wire removed.

A laser fiber is passed up the catheter so its tip lies at the highest point to be heated (usually your groin crease). A large quantity of local anesthetic solution is then injected around the vein through multiple tiny needle pricks. All staff and the patient put on laser safety specs as a precaution. The laser is then fired up and pulled down the vein for about 5 minutes. You will hear a warning buzzer ringing and may smell or taste burning but won’t feel any pain. If you’re having both legs treated the process is repeated on the other leg. The laser and catheter are removed and the needle puncture covered with a small dressing.

The treatment takes about 20-30 minutes per leg. You may also have some foam sclerotherapy or some avulsions undertaken and a compression stocking is then put on.

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Frequently Asked Questions

What is EVLA?

EVLA is a new method of treating varicose veins without surgery. Instead of tying and removing the abnormal vein,s they are heated by a laser. The heat kills the walls of the veins and the body then naturally absorbs the dead tissue and the abnormal veins are destroyed. It can be carried out in a simple treatment room rather than an operating theatre.

Are my veins suitable for EVLA?

Almost all patients with varicose veins are suitable for EVLA. Those few who are not suitable (usually those with small recurrent veins after previous surgery) can usually be managed with just foam sclerotherapy.

Are all lasers the same?

Most of the lasers used for EVLA are almost identical. Some new types claim to cause less pain than the standard lasers. There does appear to be some truth in this, although the degree of pain experienced by most patients with standard lasers is minimal and easily tolerated. The new lasers have not undergone the same extensive clinical testing and therefore we don’t know for certain if they will be as effective, especially in the longer term.

Will I need further treatment?

If you are having a treatment just to relieve symptoms then no further treatment is usually necessary. Most patients, however, wish also to improve the appearance of their veins and these about 80% will require further treatment. The varicosities normally become less obvious after EVLA but rarely disappear completely.

Additional treatment for the varicosities can be either by avulsions or foam sclerotherapy. These additional treatments can be undertaken at the time of the EVLA or more usually after a delay of 4-6 weeks. If you have extensive varicose veins on both legs it is very unlikely that you will be able to have all the additional treatment undertaken at the time of the EVLA.

Avulsions are undertaken after the local anesthetic solution has been injected around the veins to numb the area. Small incisions are made over the veins and they are teased out with a crochet hook. You may require many small incisions but they heal easily without stitches and with minimal scarring.

Foam sclerotherapy is the commonest means of dealing with residual varicose veins after EVLA and is highly effective for these.

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