Endovenous Laser Ablation (EVLA)

Over the past decade, endovenous laser ablation (EVLA) has become the gold standard in the treatment of venous reflux disease. It has a higher success rate and lower complication rate than surgical ligation and stripping of varicose veins.

How does EVLA differ from external vascular laser treatment?

Unlike external laser treatment, EVLA seals the vein from within, using laser energy. It involves the insertion of a laser fibre optic cable into the target vein under direct real time ultrasound guidance. The laser fibre is then passed up to uppermost point of venous reflux. A local anaesthetic mixture (tumescent anaesthesia) is then infiltrated around the outside of the vein, ensuring that the vein is completely anaesthetised for the procedure. The laser fibre optic cable is connected to a laser with a wavelength of 1470nm. The laser is then activated as the fibre is withdrawn. This has the effect of sealing the vein from the inside. The entire procedure is carried out under visualisation using ultrasound.

362-EVLA diagramEVLA steps: 1. Optical fibre inserted into vein. 2. Fibre advanced to target segment of vein. 3 & 4. Fibre withdrawn whilst laser is activated, vein is sealed from within.

361-Fibre optic cableEVLA is the treatment of choice for varicose veins greater than 6mm in diameter that are straight and not close to the skin surface. Truncal (axial) reflux, namely reflux of the Great Saphenous Vein (GSV), the Small Saphenous Vein (SSV) or both, is the the prime target for EVLA. Often tributary reflux, such as reflux of the accessory GSV will also represent a good option. These larger veins are usually situated in their own fascial compartments located deeper under the skin. Even the most powerful external vascular laser systems are not capable of penetrating to this depth. The reason why EVLA is so successul is due to the fact that the sealing of the vein takes place within the vein itself. This is further enhanced by the use of tumescent anaesthesia, which has the effect of compressing and pushing the vein wall against the laser fibre optic caple, ensuring effective transfer of energy. Tumescent anaesthesia has the added benefit of minimising adverse effects such as bruising.

Other visible, large varicose veins may not always be suitable for EVLA if they are too close to the skin surface (risking heat damage to the skin) or too tortuous to allow for the passage of the laser fibre. These veins are usually treated with ultrasound guided sclerotherapy (UGS) following EVLA.

In the vast majority of cases, UGS and direct vision sclerotherapy is required several weeks later to treat the remaining veins.

Just like ultrasound guided sclerotherapy, ultrasound duplex scanning is mandatory prior to the procedure. This allows the anatomy of the leg veins and the location of the reflux to be determined. The map is the work plan and a reference point for the future. Together with the initial consultation, the mapping will determine if your veins are suitable for EVLA.

 

How much does vein treatments cost?

The cost of vein treatment can vary considerably depending on different factors, such as the extent, distribution and severity of the abnormal veins. It is therefore not possible to give a cost estimate without gaining a proper understanding of the extent of your venous problem.

To request an appointment with Dr Jennifer Leung to discuss your suitability for a vein treatment please email us or call us on 02 6255 8988.