Endovenous laser ablation (EVLA) for leg ulcers
Endovenous laser ablation (EVLA) is used to treat the underlying condition of venous insufficiency that can lead to the development of leg ulcers.
It is proven to improve healing rates compared to traditional bandaging and compression management.
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What is endovenous laser ablation (EVLA)?
Endovenous laser ablation (EVLA) is used to treat the underlying conditions of venous insufficiency and hypertension that can lead to the development of leg ulcers. This leg ulcer treatment restores healthy blood flow to the legs by getting rid of faulty veins and forcing blood to flow through remaining healthy ones.
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 is not usually painful. Most patients describe both the procedure itself, and the following recovery period, as uncomfortable rather than painful.
What does EVLA involve?
Endovenous refers to ‘inside the vein’, and ablation is a medical term meaning ‘to destroy’. Therefore, EVLA is the procedure of destroying the affected veins, from the inside, with a laser.
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 venous hypertension, contributing to your leg ulcer(s).
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.
Recent studies have shown that EVLA leg ulcer treatment both improves healing times and reduces the recurrence rate, compared to compression therapy alone.
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 cause of your venous hypertension.
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 leg ulcer treatment. 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 venous insufficiency and hypertension.
Due to the local anaesthetic given, you should not feel any pain during the EVLA procedure. 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 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 leg ulcer 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.
We recommend wearing the compression stocking we provide for one week after your EVLA leg ulcer treatment. After this you should resume your usual practices of bandaging and compression therapy with your usual doctor, until your leg ulcer is fully healed.
Treatment risks
As with all medical procedures, it’s important that you weigh up the benefits of having EVLA leg ulcer 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
We recommend that all patients attend for a follow-up appointment approximately 6 to 8 weeks following EVLA leg ulcer treatment. If you also have varicose veins, it is likely that you will require some form of follow-up treatment to address the visible varicosities (blue or purple veins showing on the legs). More importantly we need to check that the EVLA treatment has successfully fixed your underlying vein problems as intended, to ensure the best possible chance of healing for your leg ulcer(s).
Although EVLA will usually have fixed the underlying problem of venous insufficiency and hypertension in your legs, it can still take some time for your leg ulcer to heal. It is important that you continue your treatment, including compression therapy, with your usual doctor following the procedure.
If you do have further follow-up treatment, such as foam sclerotherapy, you will need to wear compression stockings from UKVC again for another full week post procedure.
EVLA pricing
Information on the total costs involved in the diagnosis and treatment of leg ulcers 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
How many appointments will I need for EVLA treatment?
When can I return to my regular activities following 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.
