Endovenous Laser Ablation (EVLA)

What is Endovenous Laser Ablation (EVLA)?

Endovenous laser Ablation, also referred to as endovenous laser treatment), is a minimally-invasive medical procedure that uses laser energy to treat the underlying cause of varicose veins. EVLA has become the standard treatment for chronic venous insufficiency, as an alternative to conventional surgery known as ligation and stripping.

How long does EVLA take? What kind of anesthesia is used?

Usually takes about 1 hour to complete, however the actual treatment time may vary depending on the patient’s unique condition. EVLA is performed using only local anesthetic, no general anesthesia is used.

How effective is EVLA?

EVLA is >95% effective in most patients.

What should I expect during the EVLA procedure?

We will have you changed into loose fitting shorts. Your legs will be cleaned and sterile drapes will be placed over your legs. Procedure will begin with the ultrasound first identifying the site of entry, followed by local anesthetic. A catheter will be placed, followed by the laser which is placed through the catheter. Once the laser is positioned at the right location using ultrasound guidance the entire area will be numbed with local anesthetic. The laser will then be activated and withdrawn from the vein which you will not feel, as the area will be numb.

How is Endovenous laser ablation different from surgery? Why choose EVLA?

The Endovenous laser ablation procedure does not remove the refluxing vein from the leg, instead it simply causes the vein to collapse in place. The body then absorbs the vein. It is therefore much less traumatic to the leg tissues and there is no need for general or spinal anesthesia. Recovery time is significantly less than with surgery. There are no significant scars with the ablation procedure. After Endovenous Laser ablation you are able to walk the same day unlike surgery where usually you are hospitalized at least for one day. EVLA is minimally invasive, relatively painless, requires almost no downtime, and is highly effective at treating venous insufficiency thus offering less chance of recurrence of varicose veins.

Is Endovenous laser ablation procedure painful?

During your procedure your leg will be numbed with anesthesia in order to control pain. There is no need for general anesthesia or intravenous sedation. The only discomfort you feel during the procedure is from the very small needles used to inject lidocaine, a local anesthetic, in the skin and around the veins we are treating

Should I take my usual medications before the procedure?

It is important to inform the Vein specialist and nurse of all the current medications you are on during your initial consultation. It is likely that you may continue to use medications such as plavix, coumadin and other blood thinners as these are likely not recommended to be stopped as risks may outweigh the benefits of stopping the medication prior to your procedures. Studies have shown that anticoagulation should not affect the outcome of the Endovenous Laser ablation procedure. We will however recommend you wear a compression hose for a longer period of time postoperatively if you are taking blood thinners. However, for the 7 days before your procedure you may elect to stop taking supplements (as the benefit of stopping these supplements prior to the procedure outweigh the risks). These supplements include Vitamin E pills, fish oil, flax seed, and all herbals or home remedies as these also may increase your risk of bleeding and bruising after the procedure.

What to expect after the EVLA? What does post-treatment care consist of?

Once the procedure is complete we will place a clean pressure dressing over your leg, and compression stockings will be placed over this bandage. It is recommended you wear both compression dressings and stockings for 24 hours, at which compression bandage and stockings may be removed allowing you to shower. After showering it is recommended that you use compression stockings for 7-10 days throughout the day and remove them at night. After the EVLA it is normal for your leg to feel swollen. The swelling that you are experiencing is the anesthesia that was placed around the vein called tumescent. You may feel swelling in your thigh, calf or lower leg, depending on which vein was treated. Usually the tumescent will be slowly absorbed by the next morning. About 2-3 hours after your procedure the tumescent anesthesia will wear off and you may begin to experience pain and soreness in the areas treated. Over the course of the next few days and week you will also notice a “pulling or tugging” sensation along the treated area as the vein which was treated is now closed. This pulling sensation will improve over the next couple weeks as you continue to heal. It is also common for you to notice bruising and tenderness along the areas treated. You may take Advil, ibuprofen, Motrin or Aleve regularly until it feels better.

Call our office if you have any questions or if these areas appear to get worse. If you have fever, chills, weakness, fainting, chest pain, difficulty breathing, severe leg pain, swelling, or redness, you must immediately call our office or go to the emergency room. If your stocking causes foot pain, leg pain or numbness in your toes please remove your stocking during the night and sleep without it. You can call us in the morning so we can further advise. It is advised to avoid sitting or standing for any period longer than 30 minutes. You are encouraged to walk following your procedure, however no other strenuous exercise such as sports or heavy lifting for 2 weeks. We advise all patients to use Dermaka or Arnica after the procedure to minimize inflammation and bruising. If you were prescribed an antianxiety medication such as Xanax or Valium you will need someone to drive you home, as we discussed or you can take a taxi, Uber or Lyft.

Are my varicose veins also treated with a laser?

It is important to understand that varicose veins are not treated with a laser, the laser ablation is responsible for treating the faulty vein that is causing your varicose veins to come about. However, we will also treat your varicose veins with sclerotherapy or with a separate procedure called a microphlebectomy depending on their size and location. Please see the Microphlebectomy and Sclerotherapy section for further explanation.

Endovenous Laser Ablation (EVLA)

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