EVLT stands for Endovenous laser treatment.. It is one of the newer methods of treating varicose veins which was initially developed about 10 years ago. For 100 years until the development of the newer Endovenous treatments, the only available operation for varicose veins was the so called stripping operation, where the main vein in the thigh was literally ’stripped’ out of the thigh by use of a plastic rod . Not surprisingly this caused a lot of bruising and discomfort to the patient after the operation. There was also a risk of damaging one of the sensory nerves in the leg and the patients needed to be asleep under general anaesthesia to tolerate the operation.. Endovenous procedures have advantages over the stripping operation as they can be done with the patient awake, there is no need to make a big cut in the leg and the bruising and recovery period are faster for the patient. Endovenous varicose veins treatment is extremely popular - so how is it done ?

Endovenous means ‘inside the vein’ This is because the surgeon passes the laser fibre up the vein from the inside rather than the surgeon cutting the vein open and stripping it out. The laser fibre is inserted using an ultrasound machine on the skin so that the surgeon can see where the vein is inside the leg without having to make a big cut in the skin to find it. The fibre is very fine (about one millimetre in diameter) so it can be inserted though a very tiny nick in the skin rather than a big cut.. This bit of the procedure is painless.

Once inside the vein the surgeon positions the fibre in the correct place (which is usually at the top of the leg) and then some injections of anaesthesia are made into the area around the varicose vein from the groin down the thigh to the knee. This numbs the area around the vein and the surgeon then infiltrates some saline (salty medical water) into the area round the vein. This bit is important for two reasons. Firstly it squashes the vein down so that it has a good contact with the laser fibre. This is important for when the laser is turned on to allow the heat of the laser to burn the vein wall. Secondly the fluid insulates the area around the vein from the heat of the laser and protects the nerves near the vein from damage from the procedure..

Once everything is in place the surgeon will turn the laser on. Laser energy is basically amplified light focused into an intense beam. The tip of the laser fibre becomes very hot, but the key useful thing about lasers is that this heat is locally focused, so does not spread outside the confines of the vein wall. The energy from the laser is sufficient to damage the varicose vein wall enough to close the vein, but not enough to damage any adjacent structures. The early types of laser fibre worked well to close the vein but had a tendency to blow holes in the vein wall as the fibre was drawn slowly down the thigh. These vein perforations tended to create more post-operative bruising than was necessary. Recent developments in laser fibre technology have led to better designs that don’t perforate the vein wall and produce less bruising and discomfort for the patient after the operation.

For a typical length of thigh vein the procedure takes about 30 minutes on the operating table. The majority of this time is in getting everything set up and the laser in the correct place - once the fibre is ready to turn on the actual ‘lasering’ part takes about 2 to 3 minutes for the average patient. Bandages are then applied to the leg and the patient can walk back to the recovery area!

Eddie Chaloner is a consultant vascular surgeon operating the specialist vein treatment centre Radiance Health, in London, England. He treats over 600 patients per year for a variety of vascular disease including varicose veins, thread veins, deep vein thrombosis, and excessive sweating.

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