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Endovenous Laser Therapy

Cleveland Vein Clinic | Smith Vein Institute | Endovenous Laser Therapy

The Endovenous Laser Therapy (EVLT) procedure involves thermal ablation of incompetent varicose veins. Unlike vein stripping, EVLA permanently closes the abnormal vein, thereby leaving it in place without surgically removing the vein.

In the past few years, the use of lasers has become an excellent alternative to surgical stripping to treat varicose veins. If you have saphenous insufficiency you are a candidate for laser therapy. Using the laser we can eliminate your vein without making any incisions in the groin or stripping your vein. The laser takes the place of stripping. This procedure is very well tolerated and done through just a needle stick. A thin laser fiber is inserted into the diseased vein, through a small puncture which does not leave a scar. Under ultrasound guidance, the laser fiber is guided up into the greater saphenous vein in the thigh or the small saphenous vein in the calf. The laser energy is delivered inside the vein thereby heating it and sealing the vein closed. The procedure is done in the office with a special local anesthetic called tumescent. It numbs the area very quickly. You are typically here for about an hour. You can resume most activities the same day. Wait 1 week before resuming heavy exercise and 2 weeks before swimming or using a hot tub.

If the vein is closed by the treatment, where does the blood go?

The varicose vein is no longer working and the blood has already been rerouted. 95% of your blood is carried by your deep system and this treatment targets only superficial veins. Because there are many veins in the leg, the blood that would have flowed through the closed vein simply flows through the other remaining healthy veins after the procedure. You will never miss it. The loss of the diseased vein is not a problem for the circulatory system, in fact, it improves circulation.

What if I need open heart surgery?

A varicose vein should not be used for a bypass. There are many other veins and arteries that can be used instead. You will never need this vein once it is removed.

The key benefits of EVLT:

  • Immediate relief from symptoms
  • No scars
  • Only a local anesthetic is needed
  • Performed in the doctor’s office
  • Treatment in about an hour
  • Can resume walking immediately with minimal pain

What is vein disease?

Veins are the blood vessels that return blood to the heart from the body. To overcome the force of gravity there are one-way valves inside the veins that open to allow blood to the heart, and close to prevent “reflux” of blood back to the body. When these valves fail to function properly, or if the vein is damaged so the valves do not completely close, blood can “reflux” backwards and pool in the vein causing a variety of complications including varicose veins.

What are the different types of vein disease?

Spider veins are the small, threadlike colored veins that are most often seen on the surface of the skin. While many people seek treatment for spider veins for cosmetic reasons, spider veins can also result in substantial discomfort requiring therapy.

Varicose veins are the large, “rope-like” veins that are typically >3 mm in diameter. Varicose veins generally grow in size over time and can result in substantial pain and complications if not treated.

What can happen if varicose veins are not treated?

Varicose veins generally worsen over time. Initially, slight pain and restlessness in the diseased leg will be felt. If untreated, this pain will increase and result in limitations with walking and cramping during sleep. Eventually, varicose veins lead to skin changes, followed by open sores, blood clots, and tissue loss.

Who should not be treated?

Patients should wait at least 3 months after pregnancy or major surgery before being treated for vein disease. Persons with deep vein thrombosis and patients who cannot ambulate for other reasons are not good candidates for treatment.

What are the complications of vein treatment?

Fortunately, endovenous laser therapy is rarely associated with any serious complications when properly performed. Common minor complications include bruising, itching, numbness and tingling, tenderness, and tightness in the treated leg for up to 2-3 weeks after treatment.

Will insurance cover the treatment?

Many insurance companies cover the treatment of vein disease that is associated with substantial pain and other complications, but individual insurance companies may limit the types of therapy that are covered. Most insurance companies require a 6-12 week trial of conservative therapy with medical grade compression stockings prior to approving laser treatment.