Endovenous Laser Ablation - EVLA
Endovenous Laser Ablation, simply known as EVLA, is a minimally invasive procedure used to treat varicose veins. Endovenous Laser Ablation is a type of procedure known as endovenous thermal ablation. In this procedure, heat is used inside the vein to close the vein, instead of the painful, risky, and lengthy ligation and stripping procedure. Ligation and stripping consists of putting the patient to sleep in an operating room of a hospital or outpatient surgery center and pulling the vein out of the leg. EVLA is a fast, safe, and effective alternative to ligation and stripping. EVLA is a simple procedure performed in the doctor’s office that takes about an hour to perform. You will hear a variety of terms used for the EVLA procedure. These include EVLT®, ELVeS® laser vein treatment, and Endovenous Laser Treatment. EVLA is one of two methods that uses heat inside the vein to close it. The other method uses radio frequency to generate heat. The RF procedure is called VNUS Closure®, or ClosureFAST®.
Ligation and stripping was once considered the treatment of choice for varicose veins. It was used for many years as nearly the only treatment for severe varicose veins. Ligation and stripping was the most effective treatment available until the endovenous methods became available. Endovenous thermal ablation using laser or radio frequency has many advantages over ligation and stripping. EVLA is an in office procedure; there is no general anesthetic and the patient returns to normal activity the same day (with minor exceptions), for most jobs there is no need to take time off work, there is no need for hospitalization, or outpatient surgery, the recovery is much shorter with EVLA, EVLA is much less painful, and EVLA is much more effective.
FAQs
- What will happen the day of my EVLA?
- Will I need to see Dr. Dupper after my EVLA?
- I heard I have to wear panty hose after my EVLA?
- How much will the EVLA hurt?
- Can I keep exercising?
- Will I be sore and for how long?
- What can I do to help make the procedure successful?
- How safe is EVLA?
1. What will happen the day of my EVLA?
Before the day of the EVLA procedure, Dr. Dupper will perform a detailed duplex ultrasound examination of your legs to identify the area of venous reflux (damaged valves). On the day of the EVLA, you will arrive at Vein Treatment Specialists, PC 15 or 20 minutes before your procedure is to start. You will be asked to read an informed consent, and you will have the opportunity to ask any questions you may have before signing it. Dr. Dupper will check your leg again with the ultrasound machine and make some marks on the leg to identify the spots that will be used to put the laser fiber into the leg. Your leg will then be washed with an anti-septic soap.
Local anesthetic (lidocaine; like the dentist uses) is used to numb the skin. Using several steps and a procedure known as the Seldinger technique, a laser fiber is inserted into the vein needing to be treated. Dr. Dupper uses ultrasound to guide the placement of the laser fiber in the precise position to treat your particular venous reflux disease.
The laser generator is then used to deliver the heat energy inside the vein being treated. As the laser "fires" the fiber is slowly pulled out, closing the diseased vein. The blood in this vein will automatically flow through normal, healthy veins. Treating the diseased veins will restore normal circulation to the legs, relieving the symptoms that caused you to seek treatment. Graduated compression stockings are applied to your leg after the EVLA procedure. The EVLA procedure takes about an hour to perform, depending on how many veins need to be treated with laser.
2. Will I need to see Dr. Dupper after my EVLA?
Yes. You will be asked to return to Vein Treatment Specialists, PC several times. You will be seen several times, usually about a month apart. At these visits you will have a repeat ultrasound test, and may have some sclerotherapy injections. Sometimes Dr. Dupper will remove some trapped blood from veins that have been treated. While it will take about a year for the results of treatment to be fully seen, you will see and feel major improvements in a few days and weeks. The repeat appointments are to make sure you are getting the most benefits from the treatment. Vein treatment is a process that takes several months. Remember that it took years to develop the veins.
3. I heard I have to wear panty hose after my EVLA?
You do not have to wear panty hose. But after treating varicose veins, it is important to keep pressure on the veins to make sure the veins remain closed while healing, or some of the veins could reopen during the healing process. Because of this, Dr. Dupper recommends that you wear graduated compression garments for several weeks after each procedure. These are usually thigh high compression stockings. There are several styles to choose from. Some patients find that the stockings are very comfortable and supportive and continue wearing them after the time recommended. Some patients stop wearing them sooner. Those who wear them for the prescribed time, and who do the prescribed exercise heal more quickly and with optimal results.
4. How much will the EVLA hurt?
The EVLA procedure is a series of numbing injections. Dr. Dupper does everything possible to make the procedure as painless as possible. Whenever a larger needle is going to be used for an injection he first gives a numbing injection with one of the smallest needles made. This is to make sure you feel the slightest amount of discomfort possible. If at any time you feel pain or discomfort, Dr. Dupper will relieve the discomfort.
5. Can I keep exercising?
Not only will you be able to keep exercising, but you are strongly encouraged to walk an hour a day for the first two weeks if you are not used to exercising. Patients who are used to exercising are asked to avoid running and other impact sports for two weeks, and are asked to avoid heavy lifting and core muscle exercise for two weeks as well. Patients who follow the exercise recommendations heal more quickly and with less discomfort.
6. Will I be sore and for how long?
After the EVLA procedure, most patients experience bruising, swelling, soreness, and tightness in the treated leg. The soreness usually subsides within a few days. Patients can return home immediately and many are able to resume work and other normal activities the very same day. Dr. Dupper emphasizes the importance of walking about an hour every day for the first two weeks after your EVLA. Heavy lifting and core muscle activity should be avoided for about two weeks.
7. What can I do to help make the procedure successful?
The most important things are to follow the recommendations for exercise, and to wear the compression stockings as recommended.
8. How safe is EVLA?
EVLA is a safe procedure. But regardless of the safety of the EVLA procedure, there are certain risks associated with any surgical procedure. Some of these risks may include numbness of the skin in some places, pulling sensation in the area of the treated vein, phlebitis (inflammation of the surrounding veins), deep venous thrombosis (blood clots in the deep vein, a VERY rare complication), infection and failure of the procedure. Dr. Dupper will discuss these risks with you before performing the procedure.
The EVLA procedure can be performed on nearly any patient suffering from bulging and painful varicose veins. You can experience relief from these symptoms and from the unsightly appearance of varicose veins through this minimally invasive office procedure.
