EVLT (Endovenous Laser Therapy)

VENOUS

Introduction / Overview

Endovenous Laser Therapy (EVLT) is a minimally invasive medical procedure used to treat varicose veins, a common venous disorder affecting millions worldwide. Varicose veins occur when veins become enlarged, twisted, and dysfunctional, often causing discomfort, pain, and cosmetic concerns. EVLT offers an effective alternative to traditional surgical vein stripping by using laser energy to close off damaged veins, thereby improving blood flow and alleviating symptoms. This therapy is important because it provides patients with a less invasive, safer, and quicker recovery option, significantly enhancing quality of life.

Anatomy / Background

To understand EVLT, it is essential to grasp the basic anatomy and physiology of the venous system in the legs. Veins are blood vessels responsible for returning deoxygenated blood from the body back to the heart. In the legs, the superficial venous system includes the great saphenous vein (GSV) and small saphenous vein (SSV), which lie close to the skin surface. These veins contain one-way valves that prevent blood from flowing backward.

Varicose veins develop when these valves become incompetent, leading to venous reflux — the backward flow of blood. This causes blood to pool, increasing venous pressure and resulting in vein dilation and tortuosity. The deep venous system lies beneath the muscles and is usually unaffected by varicosities but can be involved in more severe cases.

Contact Us

VENOUS

Causes / Etiology

Several factors contribute to the development of varicose veins and the need for treatments like EVLT:

Genetic Predisposition: Family history is a strong risk factor.
Age: Vein elasticity decreases with age, increasing valve failure risk.
Gender: Women are more prone due to hormonal influences, pregnancy, and contraceptive use.
Obesity: Excess weight increases venous pressure.
Prolonged Standing or Sitting: Occupations requiring long periods of immobility impair venous return.
Pregnancy: Increased blood volume and hormonal changes affect vein walls and valves.
Previous Deep Vein Thrombosis (DVT): Can damage valves and veins.
Sedentary Lifestyle: Reduces calf muscle pump efficiency.

Symptoms / Clinical Presentation

Patients with varicose veins typically present with:

Visible, bulging, twisted veins on the legs.
Aching, heaviness, or throbbing sensations, especially after prolonged standing.
Swelling in the lower legs and ankles.
Itching or skin irritation around affected veins.
Muscle cramps or restless legs.
Skin discoloration or eczema near the ankles.
In advanced cases, venous ulcers may develop.

Diagnosis

Diagnosis of varicose veins and suitability for EVLT involves:

Clinical Examination: Inspection and palpation of the legs to identify visible varicosities and assess symptoms.
Duplex Ultrasound: The gold standard imaging modality that evaluates vein anatomy, valve function, and blood flow direction. It helps identify reflux and maps the venous system for treatment planning.
Venography: Rarely used, involves injecting contrast dye to visualize veins but is largely replaced by ultrasound.
Photoplethysmography or Air Plethysmography: Non-invasive tests to assess venous function.

Treatment Options

Non-Surgical Treatments

Compression Stockings: Improve venous return and reduce symptoms but do not eliminate varicose veins.
Lifestyle Modifications: Weight loss, exercise, leg elevation, and avoiding prolonged standing.
Medications: Venoactive drugs may provide symptomatic relief but do not cure varicose veins.

Surgical and Procedural Treatments

Endovenous Laser Therapy (EVLT): Uses laser energy to ablate the affected vein from inside.
Radiofrequency Ablation (RFA): Similar to EVLT but uses radiofrequency energy.
Sclerotherapy: Injection of a sclerosant to close smaller veins.
Vein Stripping and Ligation: Traditional surgery involving vein removal, now less common.
Phlebectomy: Removal of superficial varicosities through small incisions.

Procedure Details: Endovenous Laser Therapy (EVLT)

Preparation: The leg is cleaned and sterilized. Ultrasound guides the procedure.
Vein Access: A small puncture is made, usually near the knee or ankle, to insert a thin catheter into the affected vein.
Tumescent Anesthesia: A solution is injected around the vein to numb the area, protect surrounding tissues, and compress the vein.
Laser Fiber Insertion: A laser fiber is advanced through the catheter to the top of the diseased vein segment.
Laser Activation: Laser energy is delivered as the fiber is slowly withdrawn, heating the vein walls, causing them to collapse and seal shut.
Completion: The catheter and fiber are removed, and compression bandages or stockings are applied.

The procedure typically lasts 30 to 60 minutes.

Postoperative Care / Rehabilitation

Compression Therapy: Patients wear compression stockings for 1 to 2 weeks to reduce swelling and support healing.
Activity: Walking is encouraged immediately after the procedure to promote circulation. Strenuous activities and heavy lifting should be avoided for a few days.
Pain Management: Mild discomfort or bruising is common and managed with over-the-counter pain relievers.
Follow-Up: Ultrasound is performed within 1 to 2 weeks to confirm vein closure and assess for complications.
Return to Work: Most patients resume normal activities within a few days.

Risks and Complications

Bruising and Swelling: Common but temporary.
Pain or Discomfort: Usually mild and short-lived.
Skin Burns or Pigmentation Changes: Rare but possible due to laser energy.
Nerve Injury: Temporary numbness or tingling near the treated vein.
Deep Vein Thrombosis (DVT): Very rare but serious.
Phlebitis: Inflammation of the treated vein.
Incomplete Closure or Recurrence: Some veins may reopen or new varicosities may develop.

Prognosis

EVLT has a high success rate, with vein closure rates exceeding 90% at one year. Most patients experience significant symptom relief and cosmetic improvement. Long-term outcomes are favorable, especially when combined with lifestyle changes and compression therapy. Recurrence can occur but is less common than with traditional surgery.

When to See a Doctor

Seek medical advice if you experience:

Visible varicose veins accompanied by pain, swelling, or skin changes.
Ulcers or sores near the ankles.
Sudden leg pain, redness, or swelling, which may indicate DVT.
Symptoms worsening despite conservative measures.
Concerns about cosmetic appearance or discomfort affecting daily life.

Early consultation allows timely diagnosis and treatment, preventing complications.

Conclusion

Endovenous Laser Therapy (EVLT) represents a modern, minimally invasive approach to treating varicose veins, offering effective symptom relief and improved quality of life. Understanding the anatomy, causes, symptoms, and treatment options empowers patients to make informed decisions. If you experience signs of venous insufficiency, consult a healthcare professional to explore whether EVLT or other treatments are appropriate for you. Early intervention can prevent progression and enhance long-term outcomes.

Explore more:

Thrombectomy/RFA (Radiofrequency Ablation)

VENOUS