Varicose Veins - Endovenous Laser Ablation (EVLA)

August 30, 2018

Introduction

What is EVLA?

Endovenous laser ablation (EVLA) is a minimally-invasive procedure that uses heat (or ‘thermal’) energy to irreversibly close the section of the varicose vein. This process is called ablation and will reduce the visibility of the vein at the skin surface.

Will I need to do any preparation?

EVLA is often undertaken under local anaesthetic, however you should confirm this with your surgeon. If this is the case you will not have to fast before the procedure. You should check with your surgeon if there are any medications (such as anticoagulation) you should stop beforehand. Many centres ask that you have not had a long-haul (over 4 hours) flight in the 2 weeks before the procedure.

Technique

What does it involve?

For this procedure the surgeon will ask you to lie in the best position for them to access the vein. If the target vein is located in the back of the calf, you will likely be asked to lie on your front. During the procedure, the surgeon will ask for the bed to be tilted with your head-up or down. This will either be to fill the vein, so it is easier to target, or empty improving the thermal energy treatment.

Modern varicose vein treatments are often undertaken under local anaesthetic. This often leads to a quicker recovery time following the treatment and means you do not have to fast beforehand. In some circumstances it may be appropriate to undertake the procedure under general anaesthetic, and it is worth clarifying this with the surgeon in your consultation.

Before starting EVLA, the surgeon will use an ultrasound machine to rescan the veins. They will then prepare the leg and drape it with sterile drapes.

Once the target vein has been identified they will inject local anaesthetic and use a small needle to access the vein. In order to fit the catheter probe into the vein easily, the surgeon may have to use a scalpel to nick the skin.

The catheter probe will be placed in the region that requires treating, but away from the main or deep veins.

The surgeon will then ask for more anaesthetic called ‘tumescence’. Tumescent anaesthesia is a mixture of local anaesthetic and cold saline. By using a series of injections of the liquid around the vein, the chance thermal damage to the surrounding tissues is reduced. Often the process requires you to be tilted with your head down to ensure spread across the length of the vein. You may feel discomfort during the process, as it can often make the leg feel tight or swollen.

The catheter probe will slowly be removed as the laser begins to heat the vein. Once the desired length is treated the instruments will be removed from your leg.

At this stage, if discussed prior to the operation the surgeon may choose to do an adjunctive procedure (see phlebectomies or foam sclerotherapy).

Post procedure course (follow-up)

The care after EVLA will depend on individual practices and needs. Typically, you will be dressed in a full-length bandage which is worn for 1-2 days. You may be given an antibiotic tablet and an injection of an anticoagulant to reduce the risk of infection and deep vein thrombosis (DVT), respectively.

In the days after the procedure you should aim to regularly mobilise. You may also be asked to wear a compression stocking to reduce the risk of DVT. In some circumstances, for example if you have a high risk of DVT, you may be asked to take an anticoagulant tablet or injection following the procedure. Always check the discharge paperwork for detailed post procedure instructions.