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What is Endovenous Laser Therapy (EVLT) of Saphenous Vein?

EVLT of GSV - for Nocturnal Leg Cramps

EVLT is an acronym for Endovenous Laser Therapy/Treatment. It is also commonly referred to as EVLA or Endovenous Laser Ablation. EVLT is a minimally invasive procedure to treat varicose (enlarged) veins in your legs. Endovenous laser therapy or endovenous laser ablation of the saphenous vein is a procedure to treat a varicose saphenous vein in the legs. The procedure uses heat energy from a laser to seal off or close off the affected saphenous vein. This closure of the vein compels the blood to go around the damaged vein to healthier veins and helps to minimize pressure and swelling in your leg.

Varicose veins are enlarged veins caused due to weak or damaged valves in the veins. They appear twisted, bulged, and blue, red, or flesh colored. They are swollen and raised above the surface of the skin and are mostly found on the thighs, back of the calves, and inside of the leg. If left untreated, they may cause serious complications, such as bleeding, infections, rashes, sores, blood clots, and phlebitis (swelling and inflammation of a vein).

Anatomy of the Saphenous Vein

The saphenous vein, commonly known as the great saphenous vein (GSV), is a large venous blood vessel running close to the inside surface of the leg from the ankle to the groin.

Blood circulates in the body through a system of blood vessels that consist of arteries and veins. Arteries carry oxygenated blood from the heart to different parts of the body. Veins are blood vessels that carry deoxygenated blood from various tissues of the body back to the heart for purification (oxygenation). The leg comprises 2 systems of veins, superficial and deep veins. The great saphenous vein is a superficial vein. Between these 2 systems, there are numerous collateral pathways to allow normal venous blood flow. When the diseased superficial system is treated, the blood gets rerouted into the deep system without affecting blood flow in the leg.

Indications for Endovenous Laser Therapy (EVLT) of Saphenous Vein

EVLT of the saphenous vein is indicated for the treatment of varicosities in the saphenous vein which is mainly caused due to high blood pressure inside your veins. Factors such as hormonal changes, obesity, lack of physical activity, standing for long hours, and pregnancy may increase the risk of a varicose saphenous vein.

Preparation for Endovenous Laser Therapy (EVLT) of Saphenous Vein

Preoperative preparation for EVLT of the saphenous vein may involve the following steps:

  • A review of your medical history and a physical examination to check for any medical issues that need to be addressed prior to surgery.
  • Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could compromise the safety of the procedure.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should inform your doctor of any medications or supplements you are taking or any medical conditions you have such as diabetes or kidney issues.
  • You may be asked to refrain from certain medications such as blood thinners or supplements that affect blood clotting for at least a week prior to the procedure.
  • You should refrain from alcohol or tobacco at least a few days before treatment and several weeks after, as it can hinder the healing process.
  • You should not consume solids or liquids at least 6 hours prior to the procedure.
  • Arrange for someone to drive you home after the procedure as you may not be fit enough to drive yourself.
  • Written consent will be obtained from you after the procedure has been explained in detail.

Procedure for Endovenous Laser Therapy (EVLT) of Saphenous Vein

Endovenous laser ablation of the saphenous vein is an outpatient (same-day) procedure and usually takes less than an hour. Generally, the procedure will involve the following steps:

  • You will lie down on the procedure table in a face-down or face-up position depending upon the site of treatment.
  • An imaging technique, such as ultrasound, is utilized to guide the procedure.
  • The leg to be treated is administered with numbing medicine to reduce any discomfort and keep you comfortable.
  • Once the skin is numb, a needle is used to make a small puncture hole on the saphenous vein.
  • A catheter (thin tube) consisting of a laser heat source/laser fiber is placed into the affected vein.
  • Additional numbing medicine may be administered around the vein prior to ablating (destroying) the varicose saphenous vein.
  • Using image guidance, the catheter is guided to the treatment site, and the laser fiber at the end of the catheter is fired up to heat up the entire length of the affected vein and seal it closed stopping the blood flow through the vein.
  • The saphenous vein eventually shrinks and fades away, eliminating vein bulging at its source and resumption of efficient blood circulation through other healthy veins.
  • The catheter and laser are removed, and the puncture hole is covered with a small dressing.

Postoperative Care and Recovery

In general, postoperative care instructions and recovery after endovenous laser ablation for varicose veins will involve the following steps:

  • You may experience pain, inflammation, and discomfort in the treated area. Medications are prescribed as needed to manage these.
  • Application of ice packs over the treated area is also recommended for 10 minutes at a time for a few days to control bruising, swelling, or pain.
  • You are advised to wear compression stockings for a few days to weeks as it can help prevent blood pooling or clotting, as well as leg swelling.
  • You are encouraged to walk 10 to 20 minutes about 3 times a day for a couple of weeks, but refrain from strenuous activities, lifting heavy weights, jumping, or running during this period.
  • Do not stand, sit, or lie down for long periods of time. Keep your legs elevated while sitting.
  • You should be able to resume most of your normal activities and return to work in a day or two.
  • You need to call your healthcare provider if you have a fever or notice swelling, pain, or infection at the catheter insertion site despite taking your prescribed medications.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Benefits of Endovenous Laser Therapy (EVLT) of Saphenous Vein

Some of the benefits of endovenous laser therapy for saphenous vein over traditional varicose vein treatments include:

  • Rapid recovery and early return to everyday activities and work
  • A quicker procedure that does not require a hospital stay
  • Minimal pain and fewer complications
  • No surgical cut is needed, just a small nick on the skin that does not require stitches
  • Safer and improved cosmetic outcome
  • High success rate and low recurrence rate

Risks and Complications of Endovenous Laser Therapy (EVLT) of Saphenous Vein

Endovenous laser therapy for the saphenous vein is a relatively safe procedure; however, as with any procedure, some risks and complications may occur, such as the following:

  • Bleeding
  • Infection
  • Pain
  • Bruises/swelling
  • Blood clots or deep vein thrombosis (DVT)
  • Damage to adjacent nerves or vessels
  • Skin burning or irritation
  • Skin discoloration

Other Vascular Procedure

  • American Board of Internal Medichine
  • American Board of Vascular Medicine
  • Society for Cardiovascular Angiography and Interventions