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Laser Venous Ablation Sclerotherapy and Phlebectomy
Chronic venous disease of the legs is one of the most common conditions and is more common in industrialized countries like the United States. Approximately half of the US population has venous disease—approximately 50% of women and 40% of men. Of these 20-25% of women and 10-15% of men will have visible varicose veins. Varicose veins affect one out of two people age 50 and older and 15-25% of all adults. People without visible varicose veins may still have symptoms. Symptoms can arise from spider veins and reticular veins, as well as from varicose veins. Your ICON Vein Care physician will help determine the cause of symptoms and a treatment plan targeting you complete vein care needs.
Greater saphenous vein reflux (GSV) is the most common cause of significant varicose veins. Traditional surgical treatment of high ligation or stripping has proven to be inferior to venous thermal ablation. In 1999, the first case of laser energy delivered from inside the vessel was reported. Since then methods for treating the entire GSV have been described. FDA approved in January 2002, endovenous laser treatment creates vein occlusion by delivery of laser energy directly into the vein lumen using a 600 micron laser fiber. Endovenous laser ablation of varicose veins uses targeted laser energy to seal the vein shut and help you look and feel better fast.
Venous laser ablation eliminates symptomatic and unsightly varicose veins with no hospital stay, no scarring and no lengthy recovery. In less than an hour you can be on your way to being symptom free from varicose veins and back to enjoying your everyday activities. This treatment is safe, fast, and effective. Please come see us in the ICON Vascular and Vein Care Clinic for a consultation. ICON, Interventional Consultants are a full service Interventional Radiology specialty certified physician group who specialize in the diagnosis and treatment of vein disease.
Endovenous laser ablation:
- Treatment in less than an hour.
- Performed in the doctor’s office or in the hospital.
- Up to 98% success rate.
- Rapid relief of symptoms.
- Return to normal activity immediately.
- No general anesthesia or hospitalization.
- No scars.
Here’s what to expect from your procedure:
- An ultrasound exam is performed to map out your vein.
- Local anesthetic is applied called tumescent.
- A thin laser fiber is inserted through a tiny entry point, usually near the knee.
- Laser energy is delivered to seal the varicose vein.
- Walking immediately after the procedure is encouraged. Resume normal daily activity; avoid rigorous activities such as gym workouts and heavy lifting for 2 weeks.
- Minor soreness and bruising for several days after treatment. A “tight” feeling at the treatment site is common.
FREQUENTLY ASKED QUESTIONS
What is EVLA or EVLT? EndoVenous Laser Ablation or treatment. Thermal ablation or venous ablation is also a commonly used terms.
How does the procedure actually work?
Through a small skin nick a laser fiber is inserted into the vein and fired inside along the length of your symptomatic varicose vein. The laser energy damages the vein walls, shrinking them closed so that blood can no longer flow through them. A layer of dilute anesthetic called tumescent protects the surrounding tissue.
Is loss of this vein a problem?
No. There are many veins in the leg. After treatment, the blood in the treated varicose veins will be diverted to normal veins with functional valves. Screening ultrasound performed by your vein specialist will ensure that your venous system can tolerate this therapy. The resulting increase in circulation will significantly relieve symptoms and improve appearance.
Why do I have varicose veins?
Family history, female gender, prior pregnancy, age, and prior blood clots can contribute to the formation of varicose vein. Under normal circumstances, the musculo-venous pump and functioning vein valves maintain vein flow away from the extremity towards the heart. Any of the causes of valve injury or vein wall dilation leads to “leaking” or incompetent valves. The system is slowly overwhelmed and vessels dilate, enlarge and become symptomatic.
| Competent Valve | Incompetent Valve |
What are the side effects and complications from this procedure?
Like all minimally invasive procedures, slight bruising is common, but usually disappears within the first few weeks. You will feel a delayed tightness (or “pulling” sensation) 4-7 days after laser treatment, which is normal and expected following a successful treatment. Skin burns, bleeding, blood clots and infection are other reported complications but are distinctly rare. These will be discussed at your clinic consultation.
All surgical procedures involve some element of risk and have the potential for complications. Balance this against the risk of complications if your varicose veins remain untreated.
Am I at risk from the laser?
You will be given a pair of special glasses to wear to protect your eyes, however this is just a precaution against accidental firing of laser energy outside the body.
What are the alternatives to this treatment?
Surgery (called ‘Ligation & Stripping’) is the traditional treatment, but it can be quite painful and often has a long recovery time. It is performed in a hospital, involves general anesthesia, leaves a scar, and has a fairly high recurrence rate (on average 10-25%).
Other alternatives include ultrasound-guided sclerotherapy (injection therapy). Injection therapy for the saphenous vein has a high recurrence rate frequently requiring re-treatment and is generally limited to smaller varicose and spider veins where it is much more effective. Sclerotherapy may be required for other veins in addition to laser veinous ablation. We will discuss this with you at your clinic consultation.
Class III (30-40mmHg) compression hose are effective treatment for symptomatic varicose veins when worn continuously. Many patients cannot tolerate wearing these for long periods of time and symptoms return immediately when not worn.
How successful is Laser Venous Ablation?
Clinical data with up to 5 years of follow-up show success rates of 93-98%. This is much higher than surgical ligation and stripping where early recurrence and failure is common. It is generally accepted that high ligation with or without phlebectomy and vein stripping are inferior with a high recurrence rate. This is so well accepted that these surgeries have been largely abandoned.
In a landmark study reported by Dr. Robert Min and colleagues, 1000 legs veins treated with laser ablation for saphenous reflux resulted in 98% success (980/1000) at up to 50 month follow-up using laser venous ablation.
Will other treatments be required?
Sclerotherapy and/or ambulatory phlebectomy may be additional treatments recommended and performed by the ICON Vein Care team. We will discuss this with you at the time of consultation.
What if I have venous skin ulcers?
Surprisingly, skin ulcers from chronic venous disease commonly have venous reflux of GSV or major tributaries as a common cause. Methodical clinical evaluation combined with venous ablation often allows rapid healing of ulcers many patients have tolerated for years.
How much does it cost?
Laser Venous Ablation, when medically necessary (e.g., for relief of symptoms), is commonly reimbursed by most carriers (including Medicare), limiting the cost to the patient. We will work closely with you in assisting you with payment options.
What happens after treatment?
You must wear Class III above the waist compression hose for 2 weeks following treatment—these will be prescribed for you during your initial consultation. At least 30 minutes of vigorous walking per day is encouraged. You must be active. No heaving lifting or straining for two weeks. A follow-up clinic appointment will be scheduled in one week along with an ultrasound.
How do I find out if I am a candidate for treatment?
Please contact the ICON, Vascular and Vein Care Clinic. We will see you in consultation and perform an ultrasound to understand which veins are involved and if you are a candidate for therapy. (contact us)
Varicose Vein Before & After Gallery
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