TREATMENT OF VARICOSE WITH ENDOVENOUS LASER ABLATION

A modern treatment (management of varicose veins with endovenous laser ablation): A revolutionary advancement was achieved in the management of giant varicose veins in early 2000s. Robert Min, an Interventional Radiologist, and his team had treated a damaged valve of great saphenous vein with Endovenous Laser Ablation (EVLA)” for the first time. Rather stripping and excising the vein with a surgical approach, this method is based on occluding the damaged valve using laser energy with intraluminal approach, similar to angiography. Since the vessel is occluded with laser energy, there leaks no blood into varicose formation, and the occluded vessel is destructed by the body over time. When saphenous vein is ablated, other varicose veins that can be seen with the naked eye also disappear gradually. When the diseased vein is eliminated, other intact veins undertake the duty of blood circulation and thus, venous circulation of the leg is maintained. This modality has been applied approximately for 6 years in our country by Interventional Radiologists.

ADVANTAGES OF ENDOVENOUS LASER ABLATION:

The procedure takes less than 1 hour and its influence on symptoms are immediately evident.
Patients can immediately engage with daily activities. A very mild pain and bruising are likely, but they disappear within 10 days. There is no incision scar or stitch. The incision made on the skin is similar to a pen point in size.
The success rate is higher and the recurrence rate is lower than traditional surgery.
Patient satisfaction rate is very high.
Success rate varies from 93% to 100%.

A very large-scale meta-analysis, published in a surgery journal, reported that in 3-year follow-up outcomes of the treatment of varicose veins, success rate is 78% for surgery (including all methods) and 94% for laser ablation. J Vasc Surg 2009, Van den bos et al, (review of 72 studies)

Based on these advantages, endovenous laser ablation is widely adopted by doctors and patients and it has quickly become popular worldwide within a short time – shorter than 5 years. Endovenous Laser Ablation has outnumbered traditional surgeries, which have been used for a century, worldwide as of 2006. It is rapidly becoming widespread by Interventional Radiologists of our country in the treatment of varicose veins.

TREATMENT OF VARICOSE VEINS WITH ENDOVENOUS LASER ABLATION:

When varicose veins are managed with endovenous laser ablation, diseased vessel(s) is/are first identified and marked with Doppler ultrasound. This vessel can be the great saphenous vein, small saphenous vein, tributary veins, Giacomini vein, duplication of great saphenous vein or accessory saphenous veins. Success of the treatment is based on detailed evaluation of all vessels with Doppler and treatment of all diseased veins.
A needle is inserted into the damaged vein and a laser fiber is deployed into the lumen of the vessel that will be treated.
Tumescent anesthesia is induced at the periphery of the vessel in order to minimize the feeling of heat and pain.
Laser energy is delivered to the whole trace of the damaged vessel, while laser fiber is drawn back in a velocity that is determined according to the diameter of the vessel. Pressure in varicose segments is reduced and regression starts immediately.
The occluded vessel is totally destructed by the body within several months. Meanwhile, foam sclerotherapy is performed for the rest of varicose veins.