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Endovenous Laser Therapy

Introduction

Indications

Before The Procedure

Procedure

Postoperative Instructions

Risks

Treatment Alternatives

Related Information

Introduction

At The Vein Centre we use the ELVeS® RADIAL Fibre with the Endo Laser Vein System. This is the first radial emitting fibre used worldwide for endovenous laser treatments of the great and small saphenous veins for superficial vein reflux. This fibre applies energy faster and more accurately than any other fibre available in the endovenous market. The radial (360⁰) energy emission ensures homogenous photothermal destruction of the vein wall, allowing safe closure of the vein.

This makes optimal use of the laser energy applied. This avoids vein wall perforation and associated thermal irritation of the surrounding tissues, minimizing intra-and post-operative pain and bruising.

The ELVeS® PainLess procedure minimises any post-operative inflammatory pain and bruising due to a 40 times or greater absorption coefficient in water compared to many other lasers that target haemoglobin.

The radial fibre requires only 1/9 of the energy delivery compared to end emitting cheaper fibres meaning the procedure can be performed without sedation or general anaesthetic. The average pain score during treatment is <1.5/10.

Indications

This procedure is an effective treatment for varicose veins. In medical terminology, varicose veins are also referred to as superficial venous insufficiency, superficial venous incompetence, and superficial venous reflux. Endovenous laser is suitable for veins that are relatively straight as it involves passing a long fibre inside the vein. Veins that are very tortuous or twisted, are better suited to other procedures such as Injection Sclerotherapy and Ambulatory Phlebectomy. Most patients have a combination of straight and tortuous veins and therefore require a multifaceted approach to treatment.

Before The Procedure

Patients must avoid long flights and general anaesthetics during the four weeks before the procedure. Long flights are classified as four hours or more. For a three-hour flight the requirement is three weeks, and for a two-hour flight the requirement is two weeks. There are no restrictions on a one-hour flight. You can eat and drink as normal, ensure that you are well hydrated. Take your normal medication.

  • Wear your below knee compression in the days before the procedure. This will reduce the venous pressure in your legs, and may reduce sensitivity in your legs during the procedure. Take a last bath or shower just before the procedure, since you won't be able to wet the limb on which the procedure will have taken place until the next day.
  • DO NOT apply any type of moisturiser to your leg on the day of the procedure. Please do not apply artificial tanning products for 1 week prior to the procedure.
  • Please have breakfast or lunch prior to your procedure and be well hydrated.
  • Please wear comfortable shoes.
  • Wear loose-fitting clothes.
  • You can take your normal medications on the day of the procedure. Please notify Dr Campbell if you are taking any blood thinners such as Aspirin or Warfarin. Please bring a list of your current medications with you.
  • If you have been professionally fitted and supplied with Grade II compression stockings, please bring these with you. If not, we can supply the stockings for a fee.
  • Finally, make sure to be relaxed. Both the anaesthesia and the procedure are very well tolerated.

Procedure

This treatment in performed at The Vein Centre in our Laser Procedure Room or at Epworth Hawthorn Day Procedure.

We use ultrasound to provide us with direct vision of the vein and to guide the whole procedure.

A small amount of local anaesthetic is injected under the skin at the laser fibre entry point and at 10cm intervals along the vein. A small 1mm incision is all that is required to access the vein.

Once the laser fibre is in position, local anaesthetic is then injected around the length of the vein. It is used to numb the vein and tissues around the vein. It also provides a safety buffer for soft tissues around the vein, allowing the dissipation of heat that is created by the laser.

The laser is then fired and slowly withdrawn along the length of the vein, directly closing the vein.

A small dressing and Class II thigh length compression stocking will then be applied. We then ask that you walk for 20 minutes and return briefly to the Rooms to make sure you have no concerns prior to leaving for home. You must arrange for someone to drive you home if you have sedation during the procedure. Less than 0.5% of patients require sedation.

The entire stay at the Rooms takes approximately 2-3 hours.

Postoperative Instructions

  • Active walking is required immediately after the procedure and on a daily basis. You must walk for a minimum of 20 minutes daily for the next week. It is the best and most natural way to prevent any complications, although they occur very rarely with this procedure.
  • Normal daily activities can usually commence straight away, however, there are some restrictions. Do not spend long periods of time on your feet and keep the leg/s elevated as much as possible when seated during the first 48hrs. For the next week you must avoid long periods standing still. Strenuous activity is best avoided for 2 weeks. Do not fly for the first 2 weeks if the flight is more than 2 hours’ duration. Flying must be avoided for 4 weeks for flights more than 4 hours. General anaesthetics must be avoided for four weeks.
  • The stockings are worn overnight. They can be removed in the morning for showering and immediately reapplied. After the first night the stockings can be removed at bedtime, they must be worn for one week.
  • Post-procedural pain should be minimal and easily controlled with Panadol. Most patients do not require analgesia after the procedure. Bruising, local swelling and some tenderness may occur after treatment. This should be temporary. Aching in the leg may persist for up to 2 weeks.
  • Avoid excessive sun exposure for 2 weeks following the procedure. Avoid any direct leg treatments that may affect the skin and risk for pigmentation, e.g., laser hair removal, waxing, chemical peeling. Please discuss timing of these treatments with Dr Campbell.

If bleeding appears on the stockings, please elevate your leg and apply local compression. Dr Campbell should be contacted via mobile phone 0412 509 504, at the Rooms on 9429 4111, or via the Epworth Hospital on 9426 6666.

Risks

Deep Vein Thrombosis

People with varicose veins are 4-9 times more susceptible to deep vein thrombosis. These blood clots can also form in the deep veins as a result of treatment of your varicose veins. This is extremely rare, occurring in less than 0.1% of patients, especially if patients follow instructions regarding stockings and walking. If you are unable to perform the required walking please discuss this with Dr Campbell prior to your procedure.

Injury to nerves

Veins and nerves lie close together. These nerves can be stretched when veins are removed or exposed to high temperatures. This can result in localised numbness that is usually temporary and recovers within 6 months. Rarely this loss of sensation is permanent or could be painful, however, it does not affect function of the leg and diminishes with time.

Infection

One of the most significant advantages of EVLT is the avoidance of a groin incision. This minimises the risk of infection significantly. Only small incisions are made and the procedure involves very little trauma to tissues surrounding your varicose veins, hence, the risk of infection is very low.

Haematoma

A haematoma is a collection of blood within the soft tissues. This is usually prevented by compression. This may be felt as a firm lump with associated bruising and discomfort. Once formed, it would not be expected that it would continue to increase in size. It is not dangerous and almost always dissolves over time. Occasionally an incision has to be made to express the blood in the haematoma, this would be via a small needle prick.

Laser burn

The laser creates heat when it is active. The tumescent anaesthesia acts as a cool barrier to minimise heat dissipation outside the vein. The treated vein sometimes lies close to the skin, especially if you are very lean. The tumescent anaesthesia also pushes the vein away from the skin to minimise any chance of skin burn. No patient has ever had the complication of a skin burn in our practice. The laser is never activated outside the vein, also minimising any risk of laser injury to skin and eyes. Protective laser goggles are worn while the laser is active to protect your eyes in case the laser is accidentally activated outside the body.

Scarring

Incisions are very small so scarring is minimised. Please tell your doctor if you have a tendency to develop keloid scarring.

Treatment Alternatives

Surgical Treatment

This usually requires an operation in hospital under general or regional anaesthesia. An ultrasound is performed pre-operatively to identify areas of venous incompetence. The procedure usually takes between 1-3 hours depending on how extensive the disease is. Your legs are marked with texta pre-operatively to identify the superficial veins that also need removal.

An incision, approximately 5cm in length, is made in the groin and/or behind the knee. A plastic fibre is then inserted into the vein and the vein is pulled or stripped out from the groin to just below the knee, where a further 1-2cm incision is made to remove the vein.

Further small incisions, 3mm in length, are made to remove the superficial veins that were marked pre-operatively. The incisions are closed using absorbable suture (it does not need to be removed).

A small to moderate amount of blood loss can occur. Your legs are then bandaged in soft cotton padding and a firm elastic bandage. An overnight stay in hospital may be required. The bandages are removed the following day and a thigh length compression stocking is applied. This is worn day and night for the first week then during the day only for 1-2 weeks.

Recovery from surgery takes approximately 3 weeks. Two to three weeks off work is usually required. The recurrence rate (further varicose veins appearing) is around 20%, however, only 10% of people will require further surgery.

The advantages of laser treatment over surgery include:

  • Less pain and bruising.
  • Fewer scars.
  • No stay in hospital.
  • No General Anaesthetic.
  • Short treatment time.
  • Excellent medical and cosmetic results.
  • Rapid return to normal activities.
  • Higher success rate.
  • Lower complication rate.

Dr Claire Campbell
Compression Fitting Service
Ultrasound
Deep Vein Thrombosis
Superficial Thrombosis and Thrombophlebitis
Varicose Veins