Endovenous Laser Ablation - EVLA
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What is EVLA? EVLA is the name for a new technique to remove varicose veins? It is sometimes called ELVES or EVLA. How does it work? A fine tube (catheter) is passed through the skin near the knee and then threaded up the diseased long saphenous vein. The tube is attached to a laser power unit that heats up the end of the catheter. The heat seals the walls of the vein so that no blood can flow through it. The operation is normally done under local anaesthetic but can be done under general anaesthetic. How is EVLA different from standard surgery? If you have varicose veins then one of the causes is normally an incompetent long saphenous vein (LSV). Research has shown that it is important to remove this vein to treat varicose veins and reduce the chance of them coming back soon. Standard surgery frequently requires a cut in the groin, under a general anaesthetic, to disconnect the LSV and then it is removed by a stripping device. This can cause dramatic bruising. EVLA avoids the need for a cut in the groin, can be done under local anaesthetic, and there is minimal bruising. This means people who have EVLA can usually return to normal activity sooner than those who have standard treatment. Is EVLA better than standard surgery? It is now thought that EVLA is as good as traditional surgery for long saphenous varicose veins. Doctors normally want to know the results of scientific studies before they are happy that one treatment is better than another. A randomised trial of EVLA and the standard technique has been done by surgeons in Leeds. This has shown that it is a valuable method for treating varicose veins. We do not know what the recurrence rates of varicose veins after EVLA are. Only time will tell. Early results suggest that EVLA has similar recurrence rates to traditional surgery. Is everyone with varicose veins able to have EVLA? No. Some people have large, winding veins that are not suitable. Your Vascular Surgeon will be happy to discuss whether your veins are suitable for EVLA. Our research suggests that about 70% of people with varicose veins can be treated with EVLA. Is EVLA all I need for my veins? EVLA will remove the major superficial veins, including the LSV and anterior thigh veins. It is, however, usually necessary to have the bulging veins around the calf removed through small cuts called avulsions or have them treated by injections followed by bandages. This can sometimes be done at the same time as EVLA. Some patients do not need avulsions after EVLA. In this situation, any small veins can be treated by sclerotherapy or varicofoam. What are the advantages of EVLA? Apart from the lack of a cut in the groin, there is minimal bruising of the leg and people can return to normal activities more quickly? What is the catch? EVLA uses special catheters that cost about £200 each. During the operation, an ultrasound machine has to be used and a technician is required to control it. The room where the procedure is done has to be specially suited for laser treatments. The operation can take longer than the standard method. Local anaesthetic has to be injected into the thigh around the vein. This can be uncomfortable. Up to 60% of people who have EVLA will need to have further treatment to get rid of the varicosities ( lumps on the legs). This should be considered when you choose which treatment you want. Is EVLA an approved method? EVLA has been approved by the Government agency NICE. At the moment it is not widely available on the NHS because of the costs involved. Are there likely to be any future problems if I have EVLA? All patients who have varicose vein surgery have a chance of wound infection, nerve injury and recurrence of the veins. The only additional risk that may occur with EVLA is the development of a cord of tissue in the thigh where the LSV has been treated. This has been seen in patients who had endoluminal diathermy, an older and less efficient method than EVLA. If the cord develops, patients feel a tightness in the thigh when they cross their legs. This usually gets better with time. Is EVLA all I need for my veins? EVLA will remove the major superficial veins, including the LSV and anterior thigh veins. It is, however, usually necessary to have the bulging veins around the calf removed through small cuts ( under local or general anaesthesia) called avulsions or injections called sclerotherapy. Are there any complications associated with EVLA? All operations carry some risks. The particular risks of EVLA are burns to the skin so a series of local anaesthetic injections are used to avoid this.About 70% of people who have EVLA can develop some discomfort in the treated vein. This is called thrombophlebitis. It gets better with simple pain killers and compression stockings. In some people with very large varicose veins, the procedure might not work. Are there any alternatives to EVLA? Apart from Traditional surgery, varicose veins can be treated with a technique called Radiofrequency ablation or VNUS. Varicofoam, foam injection of varicose veins is another new technique used by Mr Braithwaite. Venocuff valve repair is a technique that Mr Braithwaite has introduced to the UK.
For a summary of options to help choose your treatment, click here. |