What are varicose veins?
Varicose veins are the enlarged, tortuous, bulging veins which are seen most often under the skin of lower extremities.
What causes varicose veins?
Varicose veins occur as a result of reverse flow of blood from the lower leg to the heart due to faulty valves. All veins have valves that open to allow the flow of blood to the heart and close to prevent backflow (otherwise known as “reflux”) of blood to the foot. When valves fail to function properly, blood leaks through and flows down the leg in the wrong direction. The blood overfills and distends the superficial vein under the skin, resulting in the bulging seen in varicose veins.
The walls and the valves of the vein are thin and elastic, and can stretch due to a variety of conditions including pregnancy, genetic and age. When varicose veins become severe, it is referred to as chronic venous insufficiency. Symptoms of chronic venous insufficiency include aching pain, leg fatigue and leg heaviness. In some cases it may lead to ulcers in the leg.
What is the Endovenous Laser Treatment (EVLT) of varicose vein?
In EVLT, laser energy is delivered through the fibre and into the vein, causing the vein wall to close. The laser fibre converts light energy to heat. The heat closes the inner lining of the diseased vein. Eventually the vein shrinks and disappears over a period of time (varying from 6 weeks to 6 months).
How EVLT is performed?
During the procedure, you are awake and lie on an treatment table. With the help of an ultrasound machine the varicose vein is identified at the level of knee. After injecting local anaesthetic under the skin a plastic sheath (catheter) is passed into the vein. Thereafter laser fibre is passed to cover the entire length of the vein with its tip protruding just beyond the catheter. The position of wire and sheath is confirmed again with the ultrasound scan and by shining the tip of laser fibre. Tissue surrounding the vein is injected with more local anaesthetic to reduce discomfort, to maximise the contact between the laser and the vein wall, and to minimise the chances of thermal damage to the overlying skin. While applying the laser energy intermittently for short periods (called pulses) the laser fibre along with the catheter is gradually withdrawn. A small dressing is applied at the puncture-site and the leg is wrapped in a compression bandage.
Why is the laser fibre placed in the thigh, when the varicose veins are located below the knee?
Bulging varicose veins in the lower leg are usually caused by a faulty valve located near the groin crease that can’t be seen at the surface. EVLT treats the source of the problem which then causes the varicose vein the lower leg, to shrink and disappear.
Which patients are suitable for EVLT?
Most patients are suitable for this form of treatment. However, there should not be any blood-clot in the deep veins of the leg, a condition called deep vein thrombosis (DVT).
Which patients are unsuitable for EVLT?
If vein is too tortuous to pass the laser fibre safely, EVLT cannot be performed. It is also not safe during pregnancy and in the patients who have extreme poor health or are non ambulatory.
What are the advantages of EVLT?
Unlike traditional varicose vein surgery EVLT can be performed while you are awake and it does not involve any cut in the groin. Therefore the possibility of wound infection and leakage or collection of a clear fluid (lymph) in the groin is less. Avoiding a cut in the groin could also prove beneficial in the long term as it probably prevents the late reconnections in the groin which cause the recurrence of the varicose veins. Unlike traditional varicose vein surgery the vein is not stripped therefore the bruising, swelling and post-operative discomfort is much less.
How successful is EVLT?
There are no long term results available however short and medium term results are quite good. According to one study the vein was successfully closed in 98% of 500 patients at 1 month and 93% at 2 years. None of the veins reopened over a period of 2 years. However one may need further sclerotherapy in outpatients for residual veins at 6-12 weeks period.
In the UK, National Institute for Clinical Excellence has approved this method in 2004 for treating varicose veins as long as there are provisions in place for after-care and follow-up.
What are the possible complications of EVLT?
The main complications are bruising and thrombophlebitis (inflammation of the superficial veins). The chances of deep vein thrombosis (DVT- blood clot in the deep veins of leg), skin- burns or feeling of altered sensation are much less in comparison to other newer modalities of treatment for varicose veins.
What should I do after the procedure?
After the procedure a tight compression stocking will be placed on your leg. You are advised to resume the normal activities immediately including walking. You will be given a compression stocking and advised to wear for 2 weeks following the procedure at all times except during sleep or shower. During these 2 weeks period you should avoid vigorous gym workouts, hot baths or excessive sun.
What should I expect after the procedure?
You should expect to see some bruising along the treated vein. This is normal and gradually goes away in a month or so. For the same length of time you may also feel some tenderness, itching and tightness in your treated leg.
Where can I get more information on varicose vein?
You can speak to your treating surgeon for clarification about any specific point. You can also find information about varicose vein including treatment options on: www.treatveins.com, www.vascularsociety.org.uk, www.nhsdirect.nhs.uk/articles