Endovenous Laser Treatment (EVLT) is a contemporary, minimally invasive procedure addressing chronic venous disease, primarily varicose veins. This condition arises from venous insufficiency or reflux, where malfunctioning valves allow blood to pool, causing veins to become enlarged and twisted. EVLT offers an advanced alternative to traditional surgical methods by utilizing focused energy to correct the underlying cause. It is widely accepted for its effectiveness and reduced recovery time.
Understanding Endovenous Laser Treatment
EVLT uses targeted thermal energy to permanently close off the problematic vein, eliminating it from the circulatory system. The underlying issue treated is venous reflux, where one-way valves fail, leading to backward blood flow and pressure buildup.
The scientific principle is thermal ablation, which generates heat directly inside the vein. A thin laser fiber delivers precise energy, causing the vein wall to collapse and seal shut, a process known as fibrosis. Once sealed, the body naturally reroutes blood flow to healthy veins nearby, and the non-functioning vein is gradually absorbed over time. EVLT is typically performed as an outpatient procedure in an office or clinic setting.
The EVLT Procedure Step-by-Step
The EVLT procedure begins with a thorough mapping of the patient’s venous anatomy using ultrasound imaging. This step is necessary to pinpoint the exact location of the incompetent vein and plan the trajectory for the laser fiber. The skin at the entry site, usually in the lower leg or near the knee, is then sterilized and prepared.
The treating physician administers a local anesthetic, often a dilute solution injected around the vein, called tumescent anesthesia. This fluid serves two purposes: it numbs the area for patient comfort and compresses the vein, protecting surrounding tissues from the laser’s heat. A tiny puncture is made in the skin, and a thin catheter is inserted into the target vein under continuous ultrasound guidance.
The laser fiber is threaded through the catheter and advanced until its tip is positioned near the top of the faulty vein, typically near the groin crease. Once the fiber is correctly placed, the laser is activated, initiating the thermal ablation process. The physician then slowly and steadily withdraws the fiber along the length of the vein. This controlled withdrawal ensures the entire length of the refluxing vein is treated. After the vein is completely sealed, the catheter and laser fiber are removed, and a small bandage is placed over the puncture site.
Recovery and Post-Treatment Expectations
Patients are encouraged to begin walking almost immediately after the EVLT procedure to promote healthy circulation and prevent blood stagnation. The physician will apply compression stockings, which must be worn continuously for a prescribed period, often ranging from one to three weeks.
These stockings provide external pressure to the treated leg, helping to keep the sealed vein closed and reducing swelling and bruising. Patients may experience mild soreness, a feeling of tightness, or a pulling sensation along the path of the treated vein for the first week or two. This discomfort is usually manageable with over-the-counter pain relief medication.
Most individuals can return to light, normal activities, including work, within a day or two following the treatment. However, strenuous activities like heavy lifting or high-impact exercise are restricted for one to two weeks. Bruising and minor discoloration at the treatment site are common and will gradually fade as the body heals.
How EVLT Compares to Other Treatments
EVLT offers distinct advantages when compared to older methods like traditional vein stripping surgery. Vein stripping requires general or regional anesthesia, involves larger incisions, and physically removes the vein, leading to a longer and often more painful recovery period. EVLT, conversely, requires only local anesthesia, is minimally invasive, and allows for a rapid return to daily life.
The high success rate of EVLT for closing larger, deeper veins, such as the Great Saphenous Vein, is comparable to surgery but with significantly less trauma to the surrounding tissues. For smaller, superficial varicose veins and spider veins, chemical ablation techniques like sclerotherapy may be more appropriate. Sclerotherapy involves injecting a liquid or foam solution to irritate and close the vein.
EVLT is generally reserved for the larger, underlying refluxing veins that feed the visible varicose veins. Sclerotherapy is often used as a follow-up or for smaller veins not suitable for the laser fiber. Low recurrence rates make EVLT the preferred initial treatment for many patients with significant venous insufficiency.