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EVL is an in-office treatment that uses laser energy, delivered directly inside the vein to eliminate varicose saphenous veins and other large varicosities . In 1999 – 2000, it was developed by Dr Carlos Bone, Dr Luis Navarro and Dr. Robert Min at the Vein Treatment Centre in Spain and in New York as a replacement for surgery in most patients with large varicose veins.
Under ultrasound guidance and local anesthesia doctors use a catheter to pass a laser fibre inside the vein. The application of laser energy causes the vein to close. With EVL, there is no need for hospitalization, general anesthesia or stitches. Following the procedure patients can walk out of the office and resume normal daily activities with the exception of strenuous exercise and prolonged standing.
The ease and success of this treatment make it a preferred method of treatment for large varicose veins.
You will have an initial consultation and diagnostic testing. During the consultation, Dr. Hill will do a physical examination and Doppler assessment (diagnostic test). Photographs may be taken of your problem area.
Diagnostic testing will help determine the source of your venous problem: the in-office Doppler will allow the doctor to hear the direction of blood flow in your veins. If the exam reveals saphenous vein incompetence (a back flow of blood in the vein) then further diagnostic testing, including color ultrasound imaging will be performed.
Varicose veins can cause pain, heaviness, swelling, aching, burning, tingling and itching. They often produce leg discomfort or restlessness at night. When severe, they can lead to rashes, ankle discolouration, phlebitis, bleeding, and leg ulcers. Varicose veins can also create a general feeling of fatigue. Their appearance may be cosmetically unappealing and result in lifestyle restrictions (like avoidance of shorts or bathing suits).
EVL is a 45 to 60 minute procedure that is performed in a medical office under only local anesthesia.
Under ultrasound guidance and local anesthesia, a catheter (hollow tube of extremely narrow diameter) is inserted into the vein and a laser fibre is passed through the catheter. Dilute local anesthetic is infiltrated around the vein to provide a cushion of fluid. The fibre and catheter are then slowly withdrawn while laser energy is released along the vein to seal it completely.
Patients experience no pain during EVL. A patient may occasionally note a feeling of heat from the laser energy.
AFTER EVL
No stitches are necessary. You will be given an anti-inflammatory medication to take for 5-7 days. The treated area will be covered with a compression pad and a thigh high support stocking will be placed on your leg. The compression pad can be removed after 7 days. The support stocking should be worn for one week minimum. You may resume normal daily activities, excluding strenuous exercise, immediately.
At 24 hours and at 5-7 days following the procedure, most patients will experience moderate bruising and some lumpiness and soreness in the treated area. All local side effects generally disappear within 1-2 weeks.
To confirm successful treatment, the doctor will perform Doppler and colour duplex ultrasound at 1 week and various monthly intervals after the procedure. Most patients will need sclerotherapy for remaining superficial varicosities and spider veins.
You should not plan on a long plane or auto trip for 3 – 4 weeks after the procedure.
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Before Treatment |
After Treatment |
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Before Treatment |
After Treatment |
Q: How much does EVL cost?
A: EVL is not covered by Alberta Health Care. The fee for treating a vein with EVL is $2200.00 per leg, payable by credit card or direct debit. This fee includes the cost of equipment, disposable sterile materials and staff and physician time.
Q: What are the advantages of EVL over ligation and stripping surgery?
A: 'Endolaser’ is a minimally invasive, in-office procedure. It requires only local anesthesia and no stitches. Patients can walk out of the office and quickly return to normal activities.
Q: Is EVL painful?
A: No. Patients report that there is no pain during the procedure. Occasionally, they do experience a feeling of heat, with brief discomfort, from the laser energy. There may be some discomfort and tenderness in the treated area for 1 -2 weeks following.
Q: How long will I be off my feet?
A: Recovery time is minimal. Patients can walk out of the office after the procedure and, in most cases, immediately resume normal daily activities, excluding strenuous exercise and prolonged standing. Long plane or auto trips should be avoided for 3-4 weeks.
Q: What are the typical side effects of EVL?
A: The common side effects are minor bruising and sometimes a sore, lumpy cord in the treated area, both of which disappear within 1-2 weeks of the procedure.
Q: How long does the procedure take?
A: Although the EVL procedure itself takes 45 to 60 minutes, the total time required including before and after treatment is approximately 2 hours.
Q:
Will I be able to drive home?
A: You will be given a medication to help you relax during the procedure so you will need someone to drive you home.
Q:
Q: Who should not have EVL?
A: Patients who are pregnant, have had a recent blood clot, have arterial occlusive disease, are in poor general health or on bed rest, are not good candidates for EVL. Occasionally, a vein may be too small or tortuous to allow passage of the catheter
and laser fiber.