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Services and Treatments Endovenous Laser Therapy (EVLT) | Injection Sclerotherapy | Microphlebectomies | Upper Endoscopy Colonoscopy | Vasectomies | Spider and Varicose Veins | Breast Care | Support Stockings | Other Office Surgeries Endovenous Laser Therapy The Procedure The Endovenous Laser Therapy (EVLT) The patient lies down on the operating table; the leg is prepped with a surgical disinfectant and draped with sterile towels. The EVLT procedure closes and seals off the saphenous vein, effectively removing it from the circulation without removing it from the body. The procedure is quick, minimally invasive, and leaves little or no scar. It has a short and relatively pain-free post-operative recovery period, and is performed under local anesthesia in Dr. Cox’s office. The treatment normally takes less than one hour. The EVLT procedure closes and seals off the saphenous vein, effectively removing it from the circulation without removing it from the body. The procedure is quick, minimally invasive, and leaves little or no scar. It has a short and relatively pain-free post-operative recovery period, and is performed under local anesthesia in Dr. Cox’s office. The treatment normally takes less than one hour. A similar procedure is called VNUS tm, which used radiofrequency energy rather than a laser. The main difference between these two types of procedures is the type of energy that is used to heat the catheter tip. The older of these two types of procedures (FDA approved in 1999) is called VNUS tm and uses radiofrequency energy (low voltage electrical current) to heat the catheter tip. The newer of these procedures (FDA approved in November 2002) is called ELVT and uses Laser energy to heat the catheter tip.
All these procedures treat the saphenous vein from the inside using a catheter with a heated tip. All procedures produce the same clinical results with no significant differences in the recovery time or potential for complications. Dr. Cox prefers the laser procedure because it is so much quicker and the heat delivery to the vein wall is much more stable. He uses the Vari-Lase ® 810 nm laser made by Vascular Solutions Inc.
The basic steps in the EVLT procedure are as follows:
The BenefitsA simple procedure - Performed under local anesthetic in the physician’s office - Minimally invasive, minimal risk of scarring or postoperative infection - Less than two hour total treatment time - Rapid recovery with reduced postoperative pain - Normal activities can be resumed immediately - Excellent clinical and cosmetic results The Risks As with any invasive procedure, there are potential complications. In the several thousand EVLT procedures that have been reported in the medical literature, the rate of complications is very low. Even though the procedure is extremely safe, the following potential risks do exist: Dr. Cox performs EVLT
- Phlebitis (an irritation of the vein, which can cause redness and tenderness). This happens approximately 90% of the time. Nearly everyone gets at least a mild phlebitis, but occasionally (2-5% of the time) the phlebitis is more severe than usual and instead of resolving in 3-5 days, it can take 7-10 days. Occasionally, it is so severe that patients have to take a day or two off work. We have never seen a post-procedure phlebitis cause any more serious consequences than a slightly prolonged discomfort and recovery. In the end, all the phlebitis goes away. - Deep Venous Thrombosis (DVT). Theoretically, anytime we place instruments on the inside of a vein we can cause it to thrombose and form a blood clot. Because we are performing this procedure near the junction of the saphenous vein (a superficial vein) with the deep vein of the leg, it is possible that we could cause a DVT. This is an extremely rare complication and has only been reported once among several thousand cases reported in the medical literature. Although we have performed several hundred EVLT procedures, we have never seen a case of DVT resulting from the EVLT procedure. This complication could potentially occur with any type of vein treatment, including sclerotherapy, laser treatment, surgery, or even bedrest. The best way to prevent this rare complication is to wear support hose and walk right after the procedure. - Failure of the procedure to completely close the saphenous vein. This has been reported to occur in about 3% of the cases that have been studied and reported in the medical literature. The reasons for failure are not completely clear to medical science, but they probably have to do with technical aspects of the procedure. We have not seen this complication in our practice. - Infection at the insertion site. This too, is mostly theoretical. If an infection were to occur at the insertion site, it would be very minor and should be of no significant consequence. - Bruising. This happens to some degree in 100% of the cases. It is usually only mildly painful, and is easily controlled with over-the-counter analgesics, such as Tylenol, ibuprofen, or aspirin. Aftercare Walking immediately following the procedure is encouraged and normal daily activity can be resumed immediately. For my patients who work, they typically return to work within one to two days. However, strenuous physical activity such as aerobics should be avoided for two weeks. Patients may experience bruising and soreness for a few days after the treatment, which occasionally requires an over-the-counter analgesic. After the procedure, the dressings and compression stocking are left in place for 48 hours. They can then be removed, and the patient can bathe or shower. The dressings are not replaced, but the compression stocking should be worn during the day for the first two weeks after the procedure. Clinical results have been published which document the success of Endovenous Laser Therapy. EVLT will normally treat the root cause of many varicose veins but additional therapies such as microphlebectomies and sclerotherapy may be necessary in some cases. FAQs How does the procedure actually work? The energy from the catheter cauterizes the vein walls, shrinking them and thus closing the faulty vein so that the blood can no longer flow through it, diverting blood to healthy veins. What are the potential complications of the procedure? There are potential complications with any medical procedure, however only minimal complications have been experienced with the Endovenous Laser Treatment procedure. Potential complications may include: vessel perforation, thrombosis, pulmonary embolism, phlebitis, hematoma, infection, paresthesia (numbness or tingling), and skin burns. If you have concerns about potential complications, Dr. Cox will discuss them with you in detail. If I have the laser procedure, am I at risk from the laser? No. You will be given a pair of special glasses to wear to protect your eyes; this is a precaution against accidental firing of laser energy outside the body. Is Endovenous Laser Therapy covered by my insurance? All insurance companies determine coverage for any treatment based on medical necessity. We have found that if your varicose veins meet your insurance company’s criteria for medical necessity, then most insurance companies in the central Ohio area are now providing insurance benefits for the EVLT procedure. It is always a good idea however, to obtain written authorization from your insurance company before proceeding with the EVLT, and Dr. Cox’s office will do this for you. Your responsibility is to make sure your insurance plan covers treatment of varicose veins. If your varicose veins are best treated by the Endovenous Laser Treatment procedure, we will send a letter to your insurance company along with your ultrasound report and a typewritten history and physical exam, asking for pre-authorization to perform the EVLT. In this way, patients will know if your insurance company will cover the procedure before going ahead with it. We can discuss your insurance coverage further at the time of consultation. How successful is Endovenous Laser Therapy? Results published in the medical literature and our own personal experiences with this procedure have been extremely favorable, with success rates as high as the conventional surgical approach of vein stripping, which is accepted as the ‘gold standard’ treatment. Endovenous Laser Therapy will normally treat the root cause of most varicose veins but additional or complimentary therapies may be necessary in some cases.
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