Endovenous Laser Ablation - Veins

Which veins are suitable for Endovenous Laser Ablation (EVLA)?

The veins that are most suitable for Endovenous Laser Ablation (EVLA or EVLT) are not the lumpy "varicose veins" that are seen on the surface nor the thread veins (or spider veins) also seen on the skin. Endovenous Laser Ablation (EVLA or EVLT) is used for the large underlying veins that cause the varicose veins. These large underlying veins are usually the truncal veins:
These truncal veins are generally relatively long and straight allowing the laser fibre or device to be passed up inside them under ultrasound control.
 
The veins that are treated with Endovenous Laser Ablation (EVLA) are too deep to be seen on the surface. Veins that can be seen on the surface cannot be treated safely with Endovenous Laser Ablation (EVLA or EVLT) as the heat generated by the laser in the destruction of the veins could potentially damage the skin.
 
With the new radial firing laser, we can also add:
using a technique called TRansLuminal Occlusion of Perforators (TRLOP). Originally TRLOP could only be used safely with radiofrequency ablation, as Incompetent Perforating Veins are very short, and forward firing endovenous lasers put the deep veins, to which they attach, at risk. However with the precise distribution of laser energy directed into the wall next to the radial firing laser tip, radial firing Endovenous Laser Ablation can now be used safely to treat Incompetent Perforating Veins using the TRLOP technique. 
 

Which veins is EVLA not suitable for?

Endovenous Laser Ablation (EVLA or EVLT) is not optimal in:
 
  • Surface varicose veins - the lumpy veins seen just under the skin. The skin would be damaged by the heat and the endovenous laser device cannot be passed along the tortuous veins.
  • Pelvic veins (Ovarian veins, testicular veins and internal iliac veins) - these veins have bowel, ureter, arteries and many other very important structures lying on them internally. If the heat from the laser ablation were to damage these, it could be disastrous.
  • Vulval varicose veins – lumpy veins in the vulva found after childbirth and usually due to pelvic vein reflux (pelvic congestion syndrome)
  • Some recurrent varicose veins particularly after stripping - although Endovenous Laser Ablation (EVLA or EVLT) is frequently successfully used in recurrent varicose veins, sometimes the veins growing back are too small, needing other treatments such as Ultrasound Guided Foam Sclerotherapy. However ‘redo’ open surgery is never needed, as there is always a local anaesthetic endovenous technique that is better than the old traditional open surgery.

Next page: How is EVLA performed?

This website was last updated on 11/10/16.

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