Laser (EVLT)

Endovenous Laser Treatment (EVLT)

Summary

• Quick, minimally invasive laser procedure

• 95% success rate

• Relief from painful and unsightly leg veins

• Major advantage compared with the alternative treatments ("stripping")

1. How does EVLT work ?

2. Preparation for EVLT?

3. What should you do after EVLT?

4. What can you expect following EVLT?

5. Possible complications from EVLT?

6. What is the Cost?

EVLT is a new procedure for the treatment of major varicose veins previously treated by stripping surgery under general anaesthetic in a hospital.

EVLT uses laser energy delivered in a thin fibre-optic probe to treat the underlying cause of the varicose veins.  Performed under ultrasound guidance and local anaesthesia allows a more gentle" minimally invasive” approach to the treatment of varicose veins.  There is minimal pain and virtually no scarring.

Initially Dr Elvy will consult with the patient about the procedure.  This consultation will include a physical examination of the leg and a Doppler ultrasound examination to map the vein to be treated.  Once the patient is determined to be a candidate for the procedure, Dr Elvy will then make an appointment for the procedure itself.

During EVLT

The vein is punctured through an anaesthetised site at about the knee for the thigh vein or the ankle for the calf vein.  A wire is passed up the vein, a 45cm long fine tube is passed over the wire, and the laser probe is introduced through the tube.  Local anaesthetic is infiltrated around the vein at several levels using extremely fine needles directed by ultrasound.  The laser tip is precisely positioned just below the end of the saphenous vein using ultrasound guidance.  The probe is activated and slowly withdrawn destroying the full length of the vein.  The procedure involves minimal discomfort.  Compression stocking is applied after treatment.

You should only experience minimal discomfort during the procedure.  Patients can return to normal activity the next day.

Before EVLT?

Cease the PILL for four weeks prior to treatment.  These can be recommenced at about three days after the procedure.  Do not apply moisturiser to your legs on the day of treatment.

After EVLT?

You will be asked to go for a 20-minute walk immediately after treatment and we encourage you to walk for 30 minutes twice each day.  Maintain normal daytime activities and avoid standing still for long periods.  Avoid strenuous physical activity such as aerobics for one week after treatment. You are required to avoid any flights of 2-4 hours duration for 4 weeks. 

If travel is unavoidable, then the flight should be covered by an injection of Clexane.

The stocking is to be worn continuously for 48 hours.  If this causes ANY pain during the night – it may be removed and reapplied first thing in the morning.  You are then required to wear the stocking for a further 5 days (7 days in all) but can be removed for showering and sleeping.  It is routine practice to perform a check ultrasound scan at 4 days after treatment.  If residual veins are shown then these will require further treatment at a subsequent appointment.

Following EVLT

The following features are expected:-

Bruising down the length of the treated vein is almost invariable and shows that the vein has been destroyed to the point where it has disintegrated in parts.

Mild to moderate pain invariably occurs commencing a day or two after treatment.  Aching in the leg persists for up to 2 weeks and shows that the procedure is effective  Soreness behind the knee can result from rubbing by the stocking.

Pain is treated with Nurofen ( from the chemist) taken three times a day , Panadol or Panadeine can also be used

Discolouration is usual early on and is not a cause for concern.  Red, raised areas can develop over tributaries but these usually disappear within 2 to 3 weeks.

Tender lumps due to clot in the treated vein are common and persist for the first few weeks.  This is an early sign that the treatment has been successful.  Lumps may appear as blood becomes trapped.  This can be removed if causing undue discomfort.  If this is the case contact the surgery.

Phlebitis or Inflammation of the treated veins can occur.  Further compression , anti inflammatory medication and regular walking can treat this.

Possible complications from EVLT

Complications can occur even with perfect technique.

Pigmentation along the treated veins consists of Haemosideran, a form of iron from the blood.  Most disappears within 12 months but there is permanent staining in about 5% and this is of cosmetic significance.  Persistent pigmentation may respond to laser treatment.

Deep vein thrombosis – clots extending into the deep veins can occur but this serious complication is extremely rare if the protocol of compression and regular daily walking is followed.  It is important to stop oral contraceptives  prior to EVLT as they increase the risk of deep vein thrombosis.

Nerve damage – The adjacent sensory nerves can suffer heat damage causing numbness but this is usually mild and rarely lasts for more than a few weeks.

Infection

Should you have any concerns following EVLT  contact the surgery during normal business hours on (02) 6658 0222 or after hours on 0412 645 322.

Failure rates  Between 95% to 98% successful vein closure

Quote will be given at time of consultation

Please note that Laser is not rebatable through Medicare