Varicose veins are permanent expansions of superficial veins, which are often lumpy, bulging or twisted in appearance. They are often caused by the imbalance of blood pressure in the superficial vein and the endurance of the vein’s walls. The most common cause of varicose veins and their enlargement is the damage of venous valves and inherent or acquired weakness of the vein walls.
Varicose veins are initially treated as a cosmetic problem. As a result of untreated disease, most often the area of sprain ankles appear swollen. Initially the swelling intensifies in the evening and tend to disappear after a night spent in a lying position.
Endovenous laser treatment EVLT
EVLT (endovenous laser treatment) is an effective and safe method of ablation. The method involves closing ineffective venous trunks with thermal energy generated by a laser. The optical fiber of the laser device is inserted into the vein through a skin puncture. The procedure is conducted under local anesthesia and the patient can return home immediately after the procedure.
Indications and preparing for surgical procedure
Before the EVLT procedure a duplex Doppler ultrasound of the lower limbs must be performed to qualify the patient. The indications for endovenous laser ablation include varicose veins in the legs, valvular incompetence in a superficial vein in the leg (great saphenous vein or small saphenous vein). The choice is also made based on the patient’s age, disease stage, and presence of coexisting diseases.
Before the procedure, blood tests must be performed: complete blood count, APTT and CRP levels, and the patient is required to wear compression stockings (class 1). The procedure is performed under local anesthesia, so the patient can eat and drink even just before the procedure.
The procedure
Upon disinfecting the limb with disinfectant solution and applying local anaesthetic, under ultrasound control, a small incision is made to the vein percutaneously, and a sterile single use radial fibre is inserted. The end of the fibre is put around the connection of the damaged superficial vein with the deep vein, where the reflux is. Then, through the skin incision a local anaesthetic solution is applied. Except for the pain relief, the solution is also supposed to protect the tissues surrounding the vein from laser thermal energy. Upon checking the position of the radial fibre, the closing of the vein will commence. The impulse work of the laser will allow to systematically pull out the radial fibre from the vein, to close it evenly. The position of the radial fibre is controlled during the entire procedure in the ultrasound. After the wire is removed from the vein, a sterile dressing is applied to the incision and a compression stocking will be put on the limb. Patient will be able to leave the operating table and after a short rest they will be able to leave the treatment room on their own.
Recommendations after treatment
preventive use of oral anticoagulants (for 10 days)
wearing a class 1 compression stocking for 24 hours after the procedure and then during the day for two weeks
follow-up visit 4 weeks after the operation (free of charge)
if the discomfort worsens, take pain relief drugs
it is not advised to drive a car directly after the treatment
Already on the next day the patient can come back to moderate physical activity (walks, climbing the stairs, work that does not require intense effort). They can return to exercise after 2-4 weeks. Follow up checks ups after the procedure are included in the price. The complications after this treatment happen rarely. Bruises can appear where the incisions were made.
Complications after the procedure are rare. Sometimes bruises may appear where the skin has been punctured.
Sometimes, the EVLT procedure is performed with (or followed by) complementary treatments such as sclerotherapy, VeinOff, or Vasculaze. Combining various treatment methods is not only effective but allows to achieve a better cosmetic effect.
Sclerotherapy
Sclerotherapy is a method of vein closure with the use of a chemical sclerosant, which is a substance that once administered into the vessel causes swelling of the vascular wall and decrease in the flow, resulting in vessel fibrosis. The procedure is almost painless and anesthesia is usually not needed at all.
Vasculaze and Lumecca lasers are used for coagulation and closure of mild vascular lesions. During the procedure, a specially designed instrument head sends light impulses causing the blood vessels to disappear. Several procedures are necessary to achieve the desirable effect and the improvement in the treatment area is gradual.
VeinOff is a method of gluing the veins with the use of a therapeutic agent – a tissue adhesive. During the procedure, a therapeutic agent is injected into the vessel. After the administration of a small amount of adhesive, the surgeon applies pressure to the injection site for about 2–3 minutes. The adhesion initiates local inflammation, which in a few weeks leads to fibrosis and complete closure of the dysfunctional vein. The procedure takes a few up to a dozen minutes and is performed during EVLT or sclerotherapy.