Endo Venous Laser TREATMENT/Ablation

• Trials were initiated in Spain in 1999. The procedure was approved by the FDA in the USA in January of 2002 and was adopted in Canada in 2003
• It is a quick, minimally invasive procedure that is performed at the doctor’s office with one tiny scar
• The procedure is performed under local anesthetic

Before the procedure:

• Don’t wear the stockings for at least 24 hours before the procedure
• Don’t take Iron supplements for 5 days prior to the procedure
• Don’t consume caffeine containing products the day of the procedure
• Don’t forget to bring your stockings the day of the procedure

The Procedure

• Takes about 45 minutes per leg
• Your veins will be mapped with ultrasound in the standing position
• You will then lie down and the leg will be cleaned with antiseptic solution and will be covered
  with sterile drapes
• Local anaesthetic (freezing) is injected at the entry point and a small cut (2-3mm) will be made
• A tube with the laser fibre inside it will be inserted in the vein
• Multiple injections of local anaesthetic will then be placed along the vein
• The laser will then be turned on and- as a precaution- protective goggles will be worn. Once the laser is activated, the tube together with the laser fibre inside it will be pulled out. This part takes about 2-3 minutes. Very
  occasionally, a transient sensation of heat or pain is experienced. You might experience a funny taste or smell
• A thigh-high compression stocking is to be worn immediately and for a total of 2 weeks. Don’t take them off for the first 2 days. From day 3 to day 14, you may take them off when you are asleep or when you shower

After the procedure

• Walk immediately
• Resume your normal daily activities
• When seated elevate your legs
• Drink plenty of non-alcoholic beverages
• Apply cold compression/ice packs over the treated areas for 15 minutes every 2 hours for the first 48h
• You may take Advil for pain relief unless otherwise contraindicated
• Don’t do strenuous exercise for the first week
• Don’t stand for prolonged hours in the first 1-2 days
• Don’t use hot tubs for 2 weeks

Expect:

• Bruising is very common and resolves completely in about 2-4 weeks
• Tightness along the treated vein felt as a “pulled muscle” or as stiffness is experienced by almost every single patient
• The treated vein could become red, swollen and feel as a firm tender cord
• You might not appreciate a difference in appearance as the treated vein is deep. The visible surface veins usually require injections that would start 1-2 months after the laser procedure and continue every 1-2 month
• A follow up appointment in 1-2 weeks
• You may need 1-2 days off work if the job is extremely physical or involves very long hours of constant standing

Possible complications:

• Superficial thrombophlebitis (inflammation with clotting of the surface veins): develops in 5% of patients and usually resolves with pressure stockings and anti-inflammatory drugs
• Numbness occurs in 3% at the incision site and improves spontaneously
• DVT (deep venous thrombosis) occurs in 0.3% of cases. Of these patients, in only 10% the blood clot may travel to the lung and can be serious. If you are diagnosed with DVT, you will require blood thinners for a period of 3-6 months
• Allergic reaction to the local anaesthetic is uncommon but possible
• The failure rate to date is about 1-2%. Those who have failed the EVLT can be successfully treated with a second EVLT session

Relative contraindications:

• Severe arterial disease where compression stockings could be contraindicated
• Severe liver disease where the local anesthetic could be harmful to the liver
• Pregnancy and lactation where safety is not known
• Limited ambulation
• Abnormal clotting