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Endovenous laser treatment (EVLT) is a minimally invasive ultrasound-guided technique used for treating varicose veins using laser energy.

Contents 1 Methods 2 Complications 3 Clinical evaluations 4 Postoperative instructions 5 References 6 External links

[edit] Methods

During the procedure, a catheter bearing a laser fibre is inserted under ultrasound guidance into the great saphenous vein (GSV) or small saphenous vein (SSV) through a small puncture. The catheter is then advanced (also under ultrasound guidance) to the level of the groin or knee crease. Dilute local anaesthetic is injected around and along the vein (perivascular infiltration). The laser is activated whilst the catheter or laser fibre is slowly withdrawn, resulting in obliteration of the saphenous vein along its entire length. The treatment, which is performed without sedation, usually takes between 1 and 2 hours and the patient walks out under his or her own power. The leg is bandaged and/or placed in a stocking that the patient wears for up to 3 weeks afterwards. Foam sclerotherapy or ambulatory phlebectomy is often performed at the time of the procedure or within the first 1–2 weeks to treat branch varicose veins. However, some physicians do not perform these procedures at the time of the EVLT because the varicose veins can improve on their own as a result of reduced reflux from the great saphenous vein.

[edit] Complications

Complications of endovenous laser treatment can be categorised as minor, or serious. Minor complications include bruising(51%), haematoma(2.3%), temporary numbness(3.8%), phlebitis(7.4%), induration(46.7%), and a sensation of tightness(24.8%). More serious complications include skin burns(0.5%), deep venous thrombosis(0.4%), pulmonary embolism(0.1%), and nerve injury(0.8%). These rates of complications are derived from the Australian MSAC review of all available literature on the procedure.^[1]

[edit] Clinical evaluations

Journal for Cardiovascular Surgery 2005 - Vol. 46 Robert J. Min, MD Neil M. Khilnani, MD - Department of Radiology Weill Medical College of Cornell University New York, NY, USA

In 2005, Doctors Min and Khilnani published their results of 1,000 limbs treated over a 5 year period with EVLT. 98% of the treated vessels at up to 60 months follow-up remain closed. Complications and side effects like temporary parasthesia and DVT's are reported at less than 0.5%.

The Australian Medical Services Advisory Commitee (MSAC) in 2008 has determined that endovenous laser treatment for varicose veins "appears to be more effective in the short term, and at least as effective overall, as the comparative procedure of junction ligation and vein stripping for the treatment of varicose veins."^[1] It also found in its assessment of available literature, that "occurrence rates of more severe complications such as DVT, nerve injury and paraesthesia, post-operative infections and haematomas, appears to be greater after ligation and stripping than after EVLT". A study of 516 treated veins over 69 months by Elmore and Lackey reported a success rate of 98.1%.^[2]

[edit] Postoperative instructions

Patients are usually fitted with Class 2 graduated compression stockings and/or bandages for up to 3 weeks. Duplex ultrasound is used during follow-up to assess the success of treatment and if there is a need for additional sclerotherapy or phlebectomy of branch veins.

[edit] References

[edit] External links

• American College of Phlebology