Endovenous Laser Ablation (EVLA)
 

Questions and Answers

 

What is EVLA?

EVLA stands for Endovenous Vein Laser Ablation, a technique for the treatment of large varicose veins that involves the insertion of a laser fiber into the veins followed by the application of laser energy to heat and kill the veins.

This technique started in about 2000, and has become very common. It is now considered to be the Gold Standard for the treatment of large varicose veins.

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What kinds of veins can be treated?

Any vein large enough for the insertion of the fiber can be treated. The most common vein that is treated is the greater saphenous vein. This vein starts on the foot and runs up the inside of the leg to the groin. It is one of the most common veins that produces varicose veins, and it is the vein that used to be "stripped".

Veins that are very twisty cannot be treated because the laser fiber cannot be passed up the vein.

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What is the success rate for EVLA?

The success rate is 95+%.* Some studies have demonstrated a 100% success rate.

The recurrence rate is also important to know. This is the number of times that new veins develop in the treated area. For EVLA this is about 2-5% in 3 years (it runs about 25% for vein surgery within 3 years)*.

*van den Bos et al, JVS 2009;49:230-39

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Don't I need this vein?

You have already lost this vein. It no longer takes blood out of your leg. In fact, the blood in varicose veins is moving back down the legs away from your heart. This can only be detrimental to you.  Treating this bad vein actually improves your circulation.

Your body has already adapted to this abnormal state. The blood going down your leg via varicose veins is removed by other healthy veins. See Vein Basics.

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What are the risks of leaving these varicose veins?

Varicose veins are prone to complications. Over years and decades, they may lead to thickening and discoloration of the skin. Eventually, varicose ulcers can develop in the skin. These are extremely difficult to treat and may persist for years.

People with varicose veins are more likely to develop blood clots in the legs.

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What are the risks of EVLA?

EVLA is a very safe technique. Serious complications are rare.

Bruising can occur following EVLA, but it is usually very mild. These bruises resolve in ten days or so.

Tenderness along the treated vein can occur and may last one week. Simple pain medication may be required, but most people don't need anything.

Marked tenderness and redness may occur in the treated area (phlebitis). This is very uncommon, perhaps 1%. This may take 3 days to 3 weeks to resolve.

Blood clots can form in the deep vessels of the legs (very rare. One in thousands).

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How many treatments will be required?

In most cases one session of EVLA is required. This session will treat the largest vein. Smaller residual veins are treated later, usually with sclerotherapy.

Two, and occasionally three, veins can be treated in a single session.

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What should I do to prepare for treatment?

Do not shave your legs the day of treatment.

Do not apply lotion or cream to your legs (tape will not stick).

Bring a pair of loose shorts. Bring long pants or a long skirt to wear afterwards.

Bring support hose to wear after treatment.

Eat well before you come to avoid hypoglycemia and fainting.

Drink lots of fluids before your treatment to fill up your veins and to prevent fainting.

Avoid exercise (even walking) prior to treatment. This may drain your veins and make accessing your veins more difficult. It is preferable to stand for a prolonged time to fill your veins.

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What can I expect during treatment?

First, an ultrasound examination is carried out to map the vein to be treated.

Then you sit on the exam bed, and a needle is inserted into the vein under ultrasound guidance.

Then you lie down, and a laser fiber is passed through the needle.

Ultrasound is used to check the placement of the fiber.

Next local anesthetic is injected along the vein. The position of the fiber is checked again.

Then the laser is turned on and the laser fiber is slowly withdrawn. This part only takes about five minutes. You won't feel anything during this part.

Support hose is applied to the leg, and you stay for fifteen minutes or so with your feet up.

After this, you get up and go home.

The whole procedure takes about one to two hours depending on complexity and the number of veins treated.

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Is the treatment painful?

The actual laser portion of the treatment is painless because local anesthetic is used. Getting the local aneasthetic in place requires several injections, and this is the only uncomfortable part of the treatment.

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What can I expect following treatment?

You will be wearing a compression stocking which must be left in place for 24 hours.

You are encouraged to be as active as possible, except in the first 24 hours when vigorous exercise should be avoided. You should walk every day.

For a few days you should avoid hot baths, saunas, hot tubs etc.

You may be a bit sore for a few days. Some people use simple analgesics like Tylenol (acetaminophen) or Advil (ibuprofen). Stronger pain medication such as codeine is not needed.

You need to wear support hose for two weeks.

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What laser is used?

At York Vein and Laser Clinic we use the CoolTouch CTEV laser because of its comfort.

With early lasers about 30% of patients experienced enough pain to need narcotics like codeine for a few days. Substantial bruising and swelling was common. About 30% of people needed two to three days off work because they were so sore.

In contrast, our CoolTouch CTEV is a much more comfortable laser. Bruising and swelling are minimal. No one needs narcotics. Most people don't even need to use Tylenol or Advil. Time off work is not required. Patients can return to their usual activities immediately. 

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Do I really need to wear support hose?

When large veins are treated, support hose is required. It is an important part of the treatment. Use of support hose decreases the rate of complications.

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Does OHIP cover the cost of EVLA?

EVLA is not covered by OHIP.

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Does extended health insurance cover the cost of EVLA? Is it a legitimate tax deduction?

Probably not, but check with your insurer. Receipts will be provided.

The cost of support hose is almost always covered by extended health insurance. Receipts and a prescription will be provided to submit to your insurer.

EVLA is a medical procedure performed by a physician for the treatment of disease. Therefore, the cost of the procedure is a legitimate medical expense that can be used as a tax credit. Health Spending Accounts can also be used to pay for the procedure.

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What are the alternatives to EVLA?

You may choose to do nothing with your varicose veins, but you risk developing complications such as venous ulcers.

Wearing support hose will reduce symptoms, slow down progression of the varicose veins, and reduce complications (ulcers and blood clots).*

Surgery can be done to strip large veins. This is a painful procedure that usually results in one to three weeks of time loss. It leaves scars. There is about a 25% chance that you will get new veins in the same area within three years. OHIP stopped covering stripping in 2012 except in patients with complictions like ulcers.

Foam sclerotherapy can be done. The success rate is very high for small veins but drops as the vein gets bigger. There may be a small residual vein following foam treatments. Using EVLA, in most cases the treated vein is no longer visible even on ultrasound a few months later.

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What is your cancellation policy?

We are booking up to 2.5 hours for your treatment. A deposit is required at the time of booking. We require one week of notice for cancellation of your appointment, in order to fill this large block of time. If sufficient notice is not given, the deposit is forfeit.

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*Results may vary.

 

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