EVLA is a minimally invasive procedure where laser energy is delivered to the faulty vein that is normally stripped during surgery, causing it to close. There are many veins in the leg, so after treatment the body simply re-routes the blood-flow through other healthy veins.
Blood in the veins normally flows up the legs, back to the heart. It is under low pressure and gravity tends to push it back down the leg. This is normally prevented by one-way valves inside the veins which allow the blood flow up, but prevent it from flowing back the wrong way.
Most varicose veins are caused by a faulty valve in the groin or behind the knee. This faulty valve allows blood to be forced out into the veins under the skin (the superficial veins) from the main veins inside the leg muscles (the deep veins). This leads to the valves in the superficial veins becoming faulty and the increased pressure in the veins causes them to enlarge (dilate) and give rise to varicose veins.
The principle behind EVLA is that the laser is used to obliterate the superficial vein (either the long or short saphenous vein), above or below the knee respectively. This stops the faulty valve in the groin or behind the knee having any effect. It achieves exactly the same as conventional surgery when a wound is made in the groin or behind the knee to put a ligature around the top of the vein which is then removed by stripping. EVLA is therefore used to treat the underlying cause of your varicose veins.
You will be asked a series of questions about any symptoms that your varicose veins are causing and any other health problems that you may have had. We will examine your legs and perform an ultrasound scan, called Doppler ultrasound. This is a form of scan that can check blood flow and direction. It will identify which faulty valves have caused your varicose veins. Scanning takes about 15 minutes per leg. It is done at an initial assessment and is also repeated at the time of EVLA. If the main faulty vein valve is in the groin or behind the knee, your varicose veins should be suitable for EVLA. We do not treat people during pregnancy, and will also take account of other medical conditions.
The procedure begins with an ultrasound scan to mark the vein in your leg to be treated. An injection of local anaesthetic is given to freeze the skin over the vein (at 4 or 5 points along it’s course). A small needle is inserted into the varicose vein (at knee level or upper calf level) and a flexible fine wire is passed up the vein to the junction at the groin or knee crease. You will not feel this. A fine tube is passed over the wire into the vein and the laser fibre is threaded up this tube.
The position of this laser fibre is then checked with ultrasound.
Once the laser fibre is in the right position some more local anaesthetic is injected around the vein to minimise any discomfort when the laser is turned on.
The laser works by shrinking the vein and closing it up from the inside. Lasers are powerful sources of energy and you and the staff will wear protective glasses whilst the laser is being used, only as an extra safety precaution. The laser light is never fired externally.
When the vein has been sealed up, the laser is removed and a graduated compression stocking or bandage is applied to the leg. You should keep this on for 7 days and nights, then during the day for 7 further days.