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Endovenous Laser Ablation


What is Endovenous Laser Ablation of Varicose Veins?

Endovenous Laser Ablation (EVLA) is a quick, minimally invasive laser procedure for the treatment of Varicose Veins, performed under local anaesthesia, that leaves no, or very minimal, scarring and has a short and relatively pain-free post-operative recovery period.
In most cases it will resolve both the symptoms and the signs of the treated varicose veins.
 
To treat Varicose Veins, and thereby alleviate the varied range of symptoms which may include; itching, venous eczema, thrombophlebitis, red and/or brown staining of the skin, bleeding and leg ulcers; the affected vein itself need not be surgically removed, we need only prevent the blood from refluxing into it.
 
This can be achieved by direct heating of he vein; causing it to shrivel up and, ultimately, to permanent closure.

There are several means of heating the vessel in this way, and one of the most successful has been shown to be EndoVenous Laser Ablation (EVLA)
 
EndoVenous Laser Ablation was Invented in 1998 mainly as a result of work done by Dr Carlos Boné from Spain, Dr Robert Min from the USA and Dr Luis Navarro from the USA, who subsequently published their work in 2001 in Dermatologic Surgery (Navarro L, Min RJ & Bone C. "Endovenous Laser: A New Minimally Invasive Method of Treatment for Varicose Veins Preliminary Observations Using an 810nm Diode Laser." Dermatologic Surgery (2001) 27: 117-122.)

Initially, the veins of the leg are examined under ultrasound, to identify the site and extent of any varicose veins.
Subsequently, local anaesthetic is applied to the leg, and a needle is passed in to the vein, followed by a guidewire, and a laser fibre ,
 
Ultrasound examination allows both the vein and the laser fibre to be visualised, ensuring it is correctly positioned.  
By applying laser energy to the fibre, a small section of the abnormal vein wall is heated, causing it to shrink and collapse. 

The laser energy heats the inside of the vein wall to a temperature of nearly 700°C. To prevent the patient feeling any pain and to prevent damage to surrounding tissues, a very dilute solution of local anaesthetic and normal saline is injected around the vein. This is called tumescent anaesthesia. 

The laser fibre can then be adjusted in position to treat additional areas. 

When completed, the laser fibre is removed and the small incision will heal without stitches.
 
Limited exercise is possible, and indeed encouraged, after the procedure. Although strenuous activity should be avoided for three or four weeks.

Some patients experience bruising and soreness for a few days after the treatment, but this does not last for long and can be treated with normal pain killers.

As with all surgical procedures, potential complications should always be discussed with your Consultant or a senior clinician prior to giving consent for the procedure.
 
Over the following weeks and months, the unsightly purple marks signifying Varicose Veins generally disappear. In some cases, the veins may not entirely disappear, in which case it may be possible to remove them via a Phlebectomy.
 
Endovenous Laser Ablation has been approved by the National Institute for Health * Clinical Excellence (NICE).  There patient guide can be downloaded here. 
 
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