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Lasers have been used for numerous medical applications throughout the body. Recently, a novel technique utilizing laser energy delivered endovenously (directly inside the vein) has been developed to treat varicose veins. An 810 nm diode laser will be used to deliver the laser energy via a small laser fiber. Endovenous laser treatment is performed under local anesthesia in the doctor’s office. There is little to no scarring and a relative short recovery period after the procedure. The procedure is called Endovenous Laser Treatment (EVLT ©); it is an outpatient procedure which means you can resume your normal activities almost immediately.
Your doctor will perform a duplex ultrasound examination using a machine that allows the doctor to visualize the blood vessels and record their size and shape. He will “map” out the venous system so he can know where all the leaky points are. Photographs of the treatment areas will be taken.
On the day of your procedure, you will: be asked, if you would like to have a low dose of the muscle relaxant Xanax. This medication will not only relax you but also the muscle in your leg. This helps from having your leg muscle tense up during the procedure. You will al,so need to have someone come with you to drive you home. You should not drive for 24 hours. You will also need to have with you, your thigh high compression hose. These are a necessity on the day of your procedure.
During the procedure, we will give you special eye goggles to protect your eyes against accidental exposure to laser light. Next, the treatment area willi be anesthetized with a common anesthetic, Lidocaine. A sterile fiber wiH be inserted into the vein and positioned under ultrasound guidance. Laser energy will be delivered to selectively treat the target vein. Our nurse will place your thigh high compression stocking on your leg, it must be worn for one week following treatment. For the next 7 days, you will not take the stocking off. You may shower with it on. If needed you may use a hairdryer to dry the stocking. If the elastic stocking does not stay up properly, you may wear reguar pantyhose over them. Another alternative may be to wrap an ace bandage around the top to help hold them up.
You will return to the office in 3 to 10 days and the doctor will examine the treated area. Doppler and duplex ultrasound evaluation will be done and additional photos may be taken. Repeat endovascular laser treatment (EVLT) using modified parameters may need to be done at the discretion of the doctor. Further treatment with compression sclerotherapy (injections) may also be needed.
Risks and Discomforts
If you undergo endovascular laser treatment (EVLT) for varicose veins, your symptoms of varicose veins may improve, remain the same, or worsen. There are several uncommon local side effects that could occur with EVLT. These include bruising, discoloration and inflammation, a large amount of swelling. They are temporary and will usually resolve in a few weeks to a few months. There are a few potential serious side effects that have never been proven, but theoretically, may occur, such as blood clots, perforation of the vein or breaking of the fiber inside the vein. Lastly, since this is a relc,tively new treatment offered by only a few super specialized specialty centers like Cornell University and Elite Vein Center there may be problems and side effects that are not known at this time that could occur. Some other after effects that may be experienced may be mild itching or soreness under your stocking. If you have large veins being treated, you may have some acing along the treated veins. You may use Benadryl for relief from itching. You ma also take Tylenol for relief from soreness. Both are available over the counter. Avoid aspirin, ibuprofen and nasaids. We will also give you a prescription for Lortab 5mg, to be used at your discretion. Please contact our office if you have any of the following symptoms:
It is highly recommended to be as active as possible. You should walk as much as you can. A brisk 30minute daily walk will be a good start. You may use a treadmill if possible. You may exercise after the first 24 hours. We do not recommend jogging, high impact aerobics, sit ups, leg lifts, squats or lifting over 15 pounds for the period of time that you are wearing your compression hose. Make sure you wear you thigh high compression stocking continuously for the first 7 days. Once you have returned to our office for your post operative ultra sound, you will be able to take the hose off at night. You will continue to wear your hose during the day for the next month. You will also return to our office for a 1-month ultra sound for follow up and additional instructions will be given.
Potential Complications Of Not Having Treatment
The potential complications of not undergoing treatment are most often limited to merely a worsening of the condition with an increase in the number of veins or enlargement in the existing veins. In cases of large varicose veins, spontaneous superficial phlebitis or bleeding may occur. Patients with varicose veins associated with underlying venous insufficiency may develop ankle swelling and/or skin changes (eczema, hyperpigmentation, ulceration). There is an increased risk of getting blood clots if you have varicose veins.
Since varicose veins and spider veins are not necessarily life threatening, treatment is not mandatory. Some patients may get adequate relief of symptoms by wearing graduated compression stockings. Alternative treatments for varicose veins include surgery, ambulatory phlebectomy, ultrasound-guided sclerotherapy (Injections), bipolar radiofrequency (heat destruction), or a combination of these treatments.
The potential benefits from the procedure are reduction in the size or closure of the treated varicose veins and improvement in your symptoms associated with the varicose veins. There is no guarantee that you will receive any medical benefit as a result of endovenous laser treatment (EVLT).
If your insurance requires a prior authorization for this procedure, our office will handle this for you. Some insurance companies may also require a pre-determination in an effort to guarantee payment for this service. Our office will also take care of this for you. It may take up to 4 to 6 weeks for one or both of these to be handled. Our office will contact you to arrange for your procedure as soon as this process is completed. Every effort will be made to work with your insurance company and you to get the procedure scheduled.
After reading this material, should you have any questions or concerns, please contact our office.
Eddy H. Luh, MD, FSVS, RPVI, FACSVascular Surgeon
Dr. Eddy Luh graduated from Cornell University. He then received his medical degree from the University of Vermont College of Medicine. Dr. Luh completed his General Surgery residency here in Nevada at the University of Nevada Affiliated Hospitals. He then trained at the world renowned ...