Endovenous laser ablation (EVLA) for varicose veins
Endovenous laser ablation (EVLA) is used to treat the underlying condition of venous insufficiency that causes varicose veins.
It is a walk-in, walk-out, minimally-invasive outpatient procedure, with minimal recovery times.
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What is endovenous laser ablation (EVLA)?
EVLA for varicose veins is used to treat the underlying condition of venous insufficiency. It restores healthy blood flow to the legs by getting rid of faulty veins and forcing blood to flow through remaining healthy ones, thus fixing both the cosmetic appearance of varicose veins and the symptoms associated with venous insufficiency.
It is a walk-in, walk-out, minimally-invasive outpatient procedure, carried out under local anaesthetic. It usually takes no more than 1 to 2 hours; depending on how many veins need treating.
EVLA for varicose veins is not usually painful. Most patients describe both the procedure itself, and the following recovery period, as uncomfortable rather than painful.
The National Institute of Health and Care Excellence (NICE) in the UK recommends EVLA as the first line treatment for varicose veins.
What does EVLA involve?
After administering a local anaesthetic, your consultant will insert a laser fibre into the vein that needs destroying, under ultrasound guidance. This laser fibre is then slowly pulled along the faulty valves, delivering heat to both ‘kill off’ and seal the vein. This process is then repeated on all of the veins that have been identified as causing your varicose veins.
Once the affected veins have been heated up and destroyed, your body will naturally absorb the dead tissue left behind. Blood is then simply diverted to your healthy veins which are functioning normally, restoring healthy blood flow to your legs.
A detailed description of EVLA treatment
Pre-procedure
Following your initial consultation, a colour duplex ultrasound scan will have been performed, identifying the faulty veins in your legs that are the root causes of your varicose veins.
You will have been provided with a full explanation of the available treatment options; including potential complications and success rates. At the start of your appointment for EVLA we will check that you fully understand all the information that has been provided to you. You will then be asked to sign the required documentation prior to the procedure.
You will also be introduced to the nurse who will be at your side throughout the EVLA treatment for your varicose veins. The procedure will take place in a small treatment room, and music of your choice will be available.
The EVLA procedure
An ultrasound scanner will be used throughout the procedure, giving the specialist a live view of your veins at all times.
Firstly, a small amount of local anaesthetic will be injected into your leg. Once this has taken effect a tiny incision will be made and a thin hollow needle will be inserted into the (first) vein to be treated, under ultrasound guidance. A guidewire (thin wire) will then be carefully inserted through the needle and into the vein that contains the faulty valves. Once this wire is in the correct position, a catheter or sheath (thin plastic tube) will then be pushed over the wire and fed along the vein. The guidewire is then removed, and the laser fibre is inserted through the catheter and into the vein.
Once the laser fibre is in position, a larger volume of local anaesthetic will be administered along the entire length of the vein to be treated. The local anaesthetic solution both numbs the leg and ensures that the tissues surrounding the vein in question are protected from damage. This involves a few small needle punctures along the leg.
Finally, once the leg is fully anaesthetised, the laser will be fired up, delivering powerful laser light and heat into the vein. The energy from the laser is absorbed by the tissues in the vein wall, which are slowly heated up to a sufficient level to kill them. The laser fibre is then slowly withdrawn along the vein, heating up and destroying the vein as it is pulled along. This will take around 5 to 10 minutes.
This procedure is then repeated on all of the veins that have been identified as causing your varicose veins.
Due to the local anaesthetic given, you should not feel any pain during your EVLA treatment. You may however feel some slight aching or soreness, and some patients may notice odd tastes and smells.
Unfortunately, we do have some patients (less than 5%) who find the injection of the local anaesthetic and the EVLA procedure for varicose veins painful. Most patients, however, describe the procedure as “uncomfortable” or the sensation of the laser moving through the vein as “weird”. If you do experience any pain, or wish to stop or pause the procedure at any time, please discuss this with the nurse or your consultant.
Once the vein has been heated up and destroyed, your body will naturally absorb the dead tissue left behind. This can take several weeks.
An extremely common question we are asked is: “If the vein has been destroyed, what happens to the blood flow?” The simple answer is that the veins which have been treated were not functioning properly anyway, so the blood is simply diverted to other healthy veins within your legs, which are still functioning normally.
Post-procedure
Once the procedure has finished, the nurse will help you put on a compression stocking (or two if you’ve had both legs treated). They’ll talk you through how to wear these and any post-treatment symptoms to look out for.
We will ask you to take a 10 minute walk following your appointment, prior to making your way home, in order to limit the risks of blood clots or deep vein thrombosis (DVT). It is important to note that you will not be able to drive immediately following treatment, but you are fine to drive the next day. You also cannot fly long haul (over 4 hours) for 4 weeks post-procedure.
Recovery
You will need to keep your compression stocking(s) on for one week following the EVLA procedure. Your nurse will explain how to wear these and bathe in them.
Over the next 4-6 weeks you may experience a slight feeling of tightness in your leg(s) as the vein shrinks and is reabsorbed into your body. You are also highly likely to experience some degree of bruising on the leg, this can range from very mild to quite severe, so please don’t be alarmed if the bruising on your leg looks more extensive than you were expecting.
The vast majority of our patients experience little to no pain following EVLA treatment, and can get back to their normal activities straight away. A small minority of patients experience more severe pain, resulting in having to take a few days off work.
The only activities we discourage during your recovery period are swimming (due to needing to wear compression stockings for one week post-treatment), horse riding and heavy weight-lifting (due to the pressure exerted on your veins). Your consultant will advise if there is anything else you should avoid.
If you were experiencing symptoms associated with your varicose veins (such as aching, heaviness, throbbing, itching, etc.), these should begin to resolve quickly following the EVLA treatment. Patients usually note that their symptoms have fully resolved when they attend for their first follow-up appointment, usually 6-8 weeks after treatment.
Treatment risks
As with all medical procedures, it’s important that you weigh up the benefits of having EVLA treatment, versus the risks of side effects. You can find a full list of risks for all our vein treatments on our treatment FAQs page.
EVLA follow-up
Following EVLA for varicose veins, we recommend that all patients attend a follow-up appointment approximately 6 to 8 weeks after treatment. The vast majority of patients will require some form of follow-up treatment to address the visible varicosities (blue or purple veins showing on the legs), and it is also important that we check that the EVLA treatment has successfully fixed your underlying vein problems as intended.
Do not be surprised if your varicose veins are still there at this stage. They are usually reduced in size, but it is very rare that they will have gone entirely by this stage. Sometimes, they will look just as large as they did before treatment, but don’t panic! This does not indicate that the EVLA treatment has failed. Although EVLA for varicose veins will usually have fixed the underlying problem of venous insufficiency in your legs, most patients will require foam sclerotherapy to treat the visible varicosities.
If you do have further follow-up treatment, such as foam sclerotherapy, you will need to wear compression stockings again for another full week.
EVLA pricing
Information on the total costs involved in the diagnosis and treatment of varicose veins is outlined on our self-funded pricing page. Alternatively, if you have medical insurance, please disregard our self-funding prices and refer to our health insurance page.
Frequently asked questions
Can EVLA alleviate the itching associated with varicose veins?
How many appointments will I need for EVLA treatment?
You can find the answers to these questions and many more in the EVLA section of our treatment FAQs page.
If you have any other questions, please do not hesitate to contact us, and a member of our clinic team will be pleased to help.
