What is EVLT Ablation?
Endovenous laser ablation (EVLT), is a minimally invasive treatment for Varicose Veins which uses heat, Generated by Laser (thermal energy) to seal off the flow of blood to the varicose veins, diverting blood flow to the healthy veins nearby. This procedure can usually be performed under local anaesthetic and is done as a day case.
What does the procedure involve? The procedure involves inserting a small catheter into the vein usually via a small incision in the leg or thigh. A small amount of local anaesthetic will be injected around the area to numb the skin. Once the catheter is inserted, a small probe will be passed down it to the top of the vein. Once the catheter is in place local anaesthetic is injected all around the vein to numb the area. The end of the catheter which transmits heat is then slowly pulled back along the length of the vein so that it heats and seals the vein. This causes the vein to collapse and the blood flow is redirected to the healthy veins nearby.
Following the procedure. After the catheter is removed from the treated vein a compression stocking will be applied to the leg. This may feel tight but should not feel so tight as to make your foot painful or discoloured. You will be required to keep the stocking in place for 7 days. After this time the stocking should continue to be worn, but only in the daytime. for a further 7 days; however you may remove it to shower or bathe. You will be encouraged to walk around very soon after the procedure and normal activity should be resumed within 1-2 days.
Benefits. You should be able to leave hospital soon after the procedure. There is usually little or no pain with the procedure. There are virtually no scars as only one small incision is made and no stitches are used. Those on blood-thinning tablets like warfarin do not have to stop it to have this treatment. Diabetic treatment does not have to be modified. Most patients have immediate symptom relief and are able to return to normal activities within a day or two.
Possible risks. Some bruising and tenderness may occur but this may be alleviated by taking simple painkillers. Some instances of heat damage to the surrounding skin and nerves have been reported but this is rare and generally disappears after a short time. Thrombophlebitis (inflammation of the vein) is not uncommon and may cause some pain and redness over the treated area but this generally responds well to non steroidal anti-inflammatory Drugs such as Ibuprofen. Blood clots can form in the deep veins in the leg (deep vein thrombosis) and can also travel to the lungs (pulmonary embolism) however these side effects are rare.
Foam sclerotherapy for varicose veins
What is sclerotherapy? The procedure called sclerotherapy or injection of varicose veins is designed to improve the appearance of your varicose veins. The veins are injected with a solution called a sclerosant which damages the internal lining of the vein and causes blood clotting within the vein. Over a period of time your own body will destroy the vein and it will disappear. The solution used is available in different concentrations depending on the size of the vein being treated and is called Sodium Tretradecyl Sulphate or “STD” for short.
What is foam sclerotherapy? Usually a solution of STD is injected directly into the vein to be treated. Foam sclerotherapy involves rapidly mixing volumes of the solution with a small volume of air producing a foam. Because of this method the foam can treat some of the larger underlying abnormal veins which would not normally be treated using conventional sclerotherapy The procedure is performed under ultrasound control. The foam solution causes intense spasm of the vein and a greater volume can be injected without using too much of the STD solution.
Is foam better than conventional sclerotherapy? The initial results with foam sclerotherapy are very promising and this method of treatment offers a possible alternative to surgery without the anaesthetic risk. However, it should be emphasised that this is a new treatment and at present the long term results are not yet known and it is not possible to say how this treatment compares in terms of results with conventional surgery or sclerotherapy.
Which veins are suitable for foam injection? Most varicose veins are suitable for this form of treatment. Foam sclerotherapy is of particular advantage to those who have had previous varicose vein operations as it avoids going through the scar tissue of previous surgery. Very extensive and large varicose veins may do better with surgery rather than sclerotherapy. If you have any underlying blood clotting tendency it may not be advisable to have sclerotherapy.
What does the procedure involve? Using ultrasound scanning, the main surface vein to be treated will be marked on your leg. The surgeon will then inject into a small area of skin, usually the mid calf or lower thigh and a needle will be placed into the vein. The needle will then be flushed with a blood thinning agent containing heparin. Then 2 or 3 smaller needles will be inserted into the visible varicose vein in the leg and the flushing procedure repeated. Your leg will be raised and the foam solution will be injected in small volumes at a time into each of the needles. During this procedure you will be asked to bend your ankle up and down in order to increase the blood flow in your deep veins. As the foam is injected you may experience some slight stinging, but it is usually painless. The passage of the foam in the vein is monitored by the ultrasound scan and the foam injections into each needle will be repeated 2 or 3 times. Once enough foam has been injected, the needles will be removed, pieces of sponge will be applied to your leg followed by a bandage in order to compress the treated veins. An elastic compression stocking will then be put on your leg, including the thigh with a waist attachment. This will feel tight but should not be so tight as to make your foot painful or discoloured.
Benefits. The benefit of having the procedure done like this is to avoid the known risks associated with having the surgery under a general anaesthetic
Possible risks. Superficial thrombophlebitis, brown pigmentation of the skin, deep venous thrombosis, skin ulceration, allergic reaction to the solution, visual disturbance or stroke are some them however they are extremely rare.
Recurrent and residual varicose veins
It is not always possible to eradicate all very small varicose veins. Depending on the number of varicose veins you may need 2, 3 or more further treatments. It is possible the vein could re-open. At the moment, the risk of this is not known and only long term follow-up data will provide this information. Should this happen, it would be possible to treat the vein again, with either a further injection or by surgery.
Clarivein is a specialty infusion catheter with a rotating wire tip designed for the controlled 360-degree dispersion of specified agents to the targeted treatment area. The Clarivein device is a slim, thin catheter (tube) that doctor temporarily inserts into the peripheral vasculature through a pin-sized entrance point. Clarivein is several times smaller than other devices used in peripheral vascular treatments allowing the entrance point to be smaller.
Why choose clarivein? Clarivein is simpler, faster and studies have shown up to 74% less pain than other minimally-invasive peripheral vascular treatments. Because no thermal energy is used, there is no need for the multiple needle-stick injections of anesthesia (pain-numbing) medication along the length of the treated area. This shortens the time the procedure takes, reduces pain and discomfort, and also eliminates bruising.