Endovenous Laser Treatment (EVLT) of Varicose Veins
Endovenous Laser Treatment (or Therapy) or EVLT began from an English developed laser - the Diomed 810nm laser. It allowed even more high flow vessels to be effectively sealed.
From about 2000 people began employing laser energy inside veins to seal the vessels related to varicose veins previously treated by surgery and ultrasound guided sclerotherapy. Initially it was felt that there was 100% persistent closure. However this did not turn out to be the case. At times there can be some occasional recanalisation and recurrence.
But the rate is less than with surgery and ultrasound guided sclerotherapy. Also there is no requirement for the patient to have a general anaesthetic with all its attendant risks. Patients appreciate the results.
The vessel needs to be large enough, straight and long enough for the laser fibre to be guided through it. With good operator experience even quite small veins can be canalised this way. But there are some that are not appropriate to treat with this modality.
To enable laser energy to be employed inside the vein a fibre-optic cable is inserted to direct the beam. This involves putting a hollow tube catheter with a guide-wire down before, and then the fibre, after the guide-wire is withdrawn.
The illustration to the left shows the new "Never-Touch" laser fibre with its gold-covered tip. The tip itself has a rounded end and allows for more even distribution of the laser energy.
The result is a more comfortable post-treatment experience with much less to, at times, no aching and minimal to no bruising.
Local anaesthetic is instilled around the vein by a series of injections (or by a long continuously instilled one) to numb the area about the vein for comfort and to absorb the extra heat generated by the laser). With our method this numbness - just around the treated vein - will last six to eight hours.
As the fibre is slowly withdrawn the laser is fired (in some this is pulsed, in others continuous firing occurs). Infra-red lasers of a range of wavelengths have been used. The target the lasers are using is mainly the red cell pigment, but some will absorb more into the water of the blood and the surrounding cells.
Endovenous laser treatment takes longer than conventional sclerotherapy, but the actual laser time is in the range of minutes.
At Springdale we began with using the Diomed laser with an 810nm wavelength and a continuous firing pattern. This laser had been the one most commonly employed for the treatment for varicose veins throughout the world. It has the longest history of use and the greatest number of recorded treatments. See more >
In 2013 the diode driving unit of our Diomed laser developed a fault. With the cost of repair and downtime while the repair was effected being weighed, I decided to purchase a new laser unit. The same manufacturing company had begun producing a longer wavelength infra-red laser, still diode-based. This is the Venacure 1470nm laser.
Since early 2013 I have been using this new unit with good results. Initial recommendations to use a lower total energy were followed but were not effective enough. With the right energy sorted patients have experienced excellent results.
On average there is less bruising and most experience a very comfortable post-treatment time. The laser fibre units are generally the same. There have been some new developments in these too, though. I have supplied some further information on the Venacure 1470nm laser.
With the other lasers employed there have been discussions about the target being treated, the amount of laser energy being used etc. As far as the energy claims are concerned, if the total dose delivered over a length of vein is calculated, the doses tend to be very similar. Some are keyed in for a lower power output but it is delivered over a longer time as the fibre is withdrawn more slowly.
Other acronyms for these treatments are EVLA (for Endovenous Laser Ablation) or similar to describe treating a vein from within by laser.
Further tidy ups of other surface varicose veins and spider veins are usually done with sclerotherapy. But, if the vessels are within the right size range, surface laser treatment can be used.
The cost of the procedure is quite a bit more than for sclerotherapy due to disposable unit costs and the lengthier time the treatment takes.
Endovenous laser treatment, or EVLT, and related procedures have proven very effective in controlling even the largest varicose veins. More and more clinics are using it as a standard procedure.