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Trials to deliver laser
energy inside veins were initiated
in Spain in
1999. The procedure was
approved by the FDA in the USA in January of
2002.
The technique was started in Canada in
2003.
EVLT is a quick, minimally invasive procedure that is
performed at the doctor's office. It only leaves a
single tiny scar. The procedure is performed under
local
anesthetic
Before the
Procedure:
DON’T:
-
Don’t
wear the stockings for at least
24 hours
-
Check with the treating physician if
you are taking blood thinners
-
Don’t
take Iron supplements for
7 days
-
Don’t
consume Alcohol or
caffeine containing
products for 24 hours
Don’t forget
to bring your stockings the day of the procedure
The Procedure
-
A digital
photo of your leg may be taken
-
Takes about
one hour per leg
-
Your veins will be
mapped with ultrasound
-
You will then
lie down and the leg will be cleaned with
antiseptic solution
-
The leg will be
covered with sterile drapes
-
All materials are
sterile and
disposable (single use)
-
Local
anaesthetic (freezing) is injected at the entry point
-
A needle is placed
through the frozen skin into the centre of the vein to be treated.
Occasionally this step induces vein spasm to the extent that
the vein diameter becomes smaller than the needle. If that is
encountered, an attempt will be made to enter the vein at a higher
point. If the higher segment goes into spasm too, it will not be
feasible to get access to the inside of the vein and the procedure
will be postponed to another day. This is a very uncommon encounter
-
A small cut
(2-3mm) will then be made and a flexible guide wire will be
inserted into the vein. You may feel the wire moving, but this
is not painful
-
A tube will then
be passed on top of the guide wire and the wire will be removed
-
The laser fibre
will be threaded within the tube that has been inserted in the vein
-
All insertions
are done under ultrasound guidance
-
Multiple
injections of local anaesthetic will
be used along the vein
-
The laser will
then be turned on and- as a precaution- protective
goggles
will be worn. Once the laser is activated, the tube together with
the laser fibre inside it will be pulled out. That part takes about
2-3 minutes. Very occasionally, a
transient
sensation of heat is experienced; otherwise, that step
is painless. You might experience a
barbeque-type taste
or smell
-
A small band aid
would then be applied to the entry point
After the
Procedure
Do:
-
walk immediately for
30 minutes or so and daily for the
first few days
-
Resume your
normal
daily activities
-
When seated
elevate your legs
-
Drink
plenty of non-alcoholic beverages
-
Ice packs over the lasered
segment for 15
minutes every 2 hours for the first
2 days
-
Anti-inflammatory
medications such as Advil helps control post-procedure
discomfort
A full thigh
compression stocking is to be worn immediately and for a total of 2
weeks. Don’t take them off for the first 2 days. From day 3 to day
14, you may take them off when you are asleep or when you shower
don’t:
-
Don’t
do strenuous exercise for the first
2 weeks
-
Don’t stand
for prolonged hours in the first few days
-
Don’t
use hot tubs for3-4 weeks
Expect:
-
Bruising
is very common and resolves completely in about
1-3 weeks
-
Tightness
along the treated vein felt as a “pulled muscle” or as stiffness is
experienced by almost every single patient. It resolves by a
week or so
-
The treated
segment will appear red and
swollen
and will feel as a firm tender cord
-
Some
of the superficial varicosities are direct branches of
the treated vein and therefore shrink with
time. If not, these would be injected at a later date.
-
the majority of the
time the lasered vein is not what you see on the surface
meaning that the difference between before and after will be
appreciated by symptoms improvement and also by shrinkage of
some of the multiple branches on the surface of the leg
-
Ultrasound
is the main follow up tool to check on success of the
procedure and also to detect any further deep branches that
might require sclerotherapy
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Annual ultrasound
is recommended to ensure long term success
Possible
complications:
-
Superficial
thrombophlebitis (inflammation with clotting of the surface
veins) develops in 5% of patients and usually
resolves with pressure stockings and anti-inflammatory drugs
-
Numbness
occurs in 3% at the incision site and improves
spontaneously
-
DVT
(deep venous thrombosis) occurs in 0.3% of cases
of which 10% will have the blood clot
migrate to the lung
and can be serious. If you are diagnosed with
DVT,
you will require blood thinners for a period of
3-6 months.
When
treated, less than 5% of DVT cases will
migrate to the
lungs with a death rate of about
1%. If
unrecognized,
25-60% of DVT may spread to the
lungs with a death rate of
15%.
The DVT rate
following EVLT is much less than that following surgical treatment
of varicose veins
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Allergic
reaction to the local anaesthetic is uncommon but possible
-
The
failure
rate is in the range of 1-2%. Those who fail the EVLT
can be re-treated successfully with a second EVLT session
Relative
contraindications:
-
Severe arterial disease where compression stockings could be
contraindicated
-
Severe liver
disease where the local anesthetic could be harmful to the
liver
-
Pregnancy
and lactation where safety is not known
-
Limited
ambulation
-
Abnormal
clotting
The long term outcome of the EVLT is not
known yet
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