Endovenous laser therapy is a quick, minimally invasive alternative to traditional vein stripping. It leaves only one small scar about ¼ of an inch or less at the insertion site. It is performed under local anesthesia with or without sedation here in our office. It also features a short, relatively pain free recovery time. Prior to treatment a physical examination is done by your surgeon and an ultrasound study of the veins in your leg(s) will be ordered and scheduled at a later date. Based on the examination and the ultrasound results, your surgeon may recommend that you have the EVLT procedure. Although published reports and clinical experience to date show this to be effective with less complication than other procedures, the long term closure rate of the saphenous vein is not known. The closure rates for one year or less are above 95%.
There are potential risks with any medical procedure. Only minimal complications have been experienced with the endovenous laser procedure, but there are potential risks with any medical procedure. Potential risks include: vessel perforation, deep vein thrombosis, pulmonary embolism, phlebitis, hematoma, infection, scarring, nerve injury, parasthesia, skin burns, post phlebitic syndrome resulting in permanent swelling of the leg, severe allergic reaction, and the remote possibility of death.
The treatment itself usually takes about an hour. First, with the patients consent, photographs may be taken of the veins in the leg for insurance, education, and marketing purposes. The area to be treated is then marked using ultrasound, and anesthetized using a local anesthetic. The leg is washed with a solution to kill any germs on the skin, and sterile drapes are applied. Ultrasound is used throughout the procedure to locate the vein to be treated and to assure proper placement of the laser fiber at all times. The laser fiber is placed through a very small incision about one quarter of an inch long near the inside of the knee. The tissue around the vein is then injected with a solution that both numbs and protects the surrounding tissues from the heat of the laser. The surgeon slowly pulls the fiber backwards through the vein while the laser energy is applied in short pulses. This causes the vein to shrink, collapse, and seal shut. Once it is sealed, the healthy veins take over and redirect blood flow back to the heart. A small adhesive strip is placed over the tiny incision to keep it closed as it heals. No stitches are needed. Absorbent pads are then placed over the injection sites as well as the incision to absorb any of the injected fluid that may drain out when you are moving about. Compression hose is placed over this and will need to be worn for 48 hours uninterrupted, then for 2 weeks while awake and on your feet.
Insurance coverage for the procedure is determined on a case-by-case basis. In most cases, insurance companies decide whether or not to cover treatment based on medical necessity. If you have concerns regarding coverage for this procedure we recommend you call your insurance company to discuss their criteria for coverage as every company is slightly different. You should also ask about coverage for compression hose that will be required after the procedure.
Early results have been extremely favorable. Success rates have been as high as those for the conventional surgical approach which is considered the "gold standard" treatment. EVLT generally treats most varicose veins successfully, but additional therapy is needed in some cases.