Chronic venous hypertension is caused when one-way valves become
damaged in the veins of the legs. Blood then moves down the
vein into the legs instead of up toward the heart. For the
largest veins, we use a laser inserted into the vein which seals
it closed with heat. This is termed endovenous laser ablation
or EVLA. Lasers use more heat than other treatments such as
radiofrequency ablation, called VNUS, therefore, long term
closure rates are 95% with laser EVLA and only about 83% with
radiofrequency VNUS.
Before the procedure, you will be evaluated for medical problems
and a duplex ultrasound examination will be performed to
determine which veins in your legs have damaged valves. Your
physician will review these results with you and together you
will decide a course of treatment.
On the morning of the EVLA procedure, shower and eat normally.
A driver is recommended to accompany you and drive you home
because Valium may be administered to help relax you and open
your veins. You will lie comfortably on a slanted surgical
table equipped with a heating pad with your head higher than
your legs. Music is available on an Ipod and we have a video
screen if you would like to watch the procedure.
The physician will perform the procedure under strict sterile
conditions. The leg will be cleaned to maintain sterility and
draped with a sterile cloth. When introducing the laser, you
will feel a needle prick in your leg, much like having blood
drawn from your arm. The laser will be inserted into your leg
vein and its position checked with ultrasound. Then you will
feel a series of numbing shots. After this, you will not be
able to feel the laser energy and it will be turned on to seal
the vein closed.
The entire process takes about 30 minutes and is very
comfortable.
After the EVLA your leg will be bandaged and your compression
stocking will be applied. It is strongly recommended that you
walk for 30 minutes after the procedure and each day to prevent
blood clots from forming. You are expected to wear the
compression hose for 5 days continuously and for the next 14
days during the day only.
You will be checked with ultrasound a week after your procedure
to ensure that the vein has remained closed and that no blood
clots have formed.
If you have more than one vein requiring treatment, these will
be done on subsequent days. After all the large veins have been
treated with EVLA, the smaller veins will be treated with foam
sclerotherapy. In this way, treating the largest veins first,
many smaller veins and spider veins may clear up without
additional treatment.
Ultrasound follow-ups are scheduled a month, three months, six
months and a year after treatment to ensure continued success.
If additional veins become incompetent, it’s best to treat them
as soon as they are detected to keep you symptom-free.
