What is Endovenous Laser Ablation for Varicose Veins?
Endovenous laser ablation is a minimally invasive, image-guided treatment for varicose veins in which laser energy is utilised to cauterise (burn) and close the abnormal veins that result in varicose veins.
Varicose veins are enlarged veins caused due to weak or damaged valves in the veins. They appear twisted, bulged, and blue, red, or flesh-coloured. 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. Laser therapy is one of the newest ways of treating varicose veins. This treatment can be performed externally or by an endovenous laser ablation method.
The endovenous (inside the vein) laser method is a minimally invasive procedure that is performed for larger varicose veins. In this procedure, a laser fibre is guided into the vein till it reaches the affected area. The fibre then emits a laser which produces heat and forms blood clots in the vessel. This blood vessel gradually shrinks and disappears. This is an outpatient procedure and takes about 30 minutes.
Indications for Endovenous Laser Ablation for Varicose Veins
Normally, blood travels from the heart to the lower limbs by arteries and back to the heart through veins. Veins have one-way valves that enable blood to return from the lower limbs against gravity. If the blood pools in the veins or the valves leak, the veins can become varicosed or enlarged. Varicose veins result from defective valves in the superficial venous system which causes blood to pool in the leg as it is not effectively returned to the heart. Endovenous laser ablation is indicated to prevent complications and treat symptoms associated with varicose veins, such as:
- Superficial venous thrombosis
- Skin discolouration
- Fibrosis (formation of excess connective tissue)
- Restless legs
- Tired legs
Preparation for Endovenous Laser Ablation for Varicose Veins
Preoperative preparation for endovenous laser ablation surgery for varicose veins 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, anaesthesia, or latex.
- You should inform your doctor of any medications or supplements you are taking or any medical conditions you have such as heart or lung disease.
- You may be asked to refrain from certain medications such as blood thinners or aspirin or vitamin/herbal supplements for a week or two 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 8 hours prior to the procedure.
- Written consent will be obtained from you after the procedure has been explained in detail.
Procedure for Endovenous Laser Ablation for Varicose Veins
Endovenous laser ablation procedure usually takes less than an hour and you may go home the same day. Generally, endovenous laser ablation for varicose veins will involve the following process:
- You will lie down on the procedure table in a face-down or face-up position depending upon which veins are being treated.
- An imaging technique, such as ultrasound, is utilised 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 vein to be treated.
- A catheter (thin tube) consisting of the laser heat source/laser fibre is placed into the affected vein.
- Additional numbing medicine may be administered around the vein prior to ablating (destroying) the varicose veins.
- Once the catheter is confirmed to be in the correct position, the laser fibre at the end of the catheter is fired up to heat up the entire length of the vein and seal it closed. This results in the stopping of blood flow through the vein.
- The problem 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.
- Instructions on bathing and incision site care will be given to keep the incision site clean and dry.
- Application of ice packs over the treated area is also recommended for 10 minutes at a time for 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 heavyweights, 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 site despite taking your prescribed medications.
- A periodic follow-up appointment will be scheduled to monitor your progress.
Risks and Complications
Endovenous laser ablation for varicose veins is a relatively safe procedure; however, as with any procedure, some risks and complications may occur, such as the following:
- Blood clots or deep vein thrombosis (DVT)
- Damage to adjacent nerves or vessels
- Skin burning or irritation over the treatment area
- Skin discolouration
Benefits of Endovenous Laser Ablation for Varicose Veins
Some of the benefits of endovenous laser ablation over traditional vein stripping procedure for the treatment of varicose veins include:
- Virtually leaves no scar in the treated leg
- Minimally invasive rather than standard varicose vein surgery
- Quicker return to normal activities and work
- Minimal pain and fewer complications
- No surgical cut is needed, just a small nick on the skin that does not require stitches
- Generally safe and improved cosmetic outcome
- Majority of the treated veins are invisible even on an ultrasound after a year