The advantages and disadvantages of Endovenous Laser Ablation (EVLA)
Endovenous Laser Ablation (EVLA or EVLT) is minimally invasive and, provided it is performed correctly, should be a permanent ablation of the treated vein.
Compared to stripping the same vein, the incision is far smaller, being a pinhole rather than a cut in the groin or behind the knee. The bruising should be far less and so the post-operative pain should be markedly reduced and post-operative mobility should be virtually normal from immediately after the procedure. There will of course be some discomfort as there has been a procedure performed. There may be some change to the sensation of the skin of the inside of the thigh, but this is usually temporary and rarely lasts for more than a few weeks.
The major advantages over stripping are firstly that Endovenous Laser Ablation (EVLA or EVLT) should be performed under a local anaesthetic as a walk-in walk-out procedure whereas with stripping, it is more common to have general anaesthetic, regional anaesthetic or sedation. Secondly if performed correctly, the vein should never re-open or grow back again, whereas after stripping, a very large number (if not the majority) of veins grow back again without valves, causing the same problem to re-occur in the medium to long-term making the stripping surgery useless.
When Endovenous Laser Ablation (EVLA or EVLT) is compared with radiofrequency ablation (which is another catheter based thermoablation technique) they are both quite similar and so there are much smaller advantages and disadvantages when compared with the huge advantages over tying and stripping.
The Endovenous Laser Ablation (EVLA or EVLT) is not as reliant on contact with the vein wall as radiofrequency ablation and is therefore preferred for larger diameter veins, veins with “blowouts” (dilated segments) or veins with clot, fibrous tissue or calcified areas within the walls. However the end firing Endovenous Laser Ablation (EVLA or EVLT) fibres and devices are more likely to cause perforations in the vein wall which can cause increased bruising (sometimes called a ecchymosis) and pain, and a small risk of regrowth of veins (called neovascularisation). The new radial firing endovenous laser device however does not seem to have this problem.
On a practical level, Endovenous Laser Ablation (EVLA or EVLT) tends to be faster than radiofrequency ablation but does need a laser proof or laser approved room and for the patient and operating staff to wear protective glasses.
When compared to some of the new devices such as the mechanical sclerotherapy catheter, steam vein sclerosis and glue sclerotherapy, it would be unfair to provide much in the way of comparison as these devices are very new in the market and need to prove that they are as effective as Endovenous Laser Ablation (EVLA or EVLT) before such comparisons are made.
However, there are a couple of comparisons that can be made between Endovenous Laser Ablation (EVLA or EVLT) and the mechanical sclerotherapy catheter with the data available at the time of writing this. On the positive side for Endovenous Laser Ablation (EVLA or EVLT); Endovenous Laser Ablation can be used for multiple veins at one treatment session whereas the mechanical sclerotherapy catheter is limited by the maximum dose of sclerosant and can only be used for one main truncal vein at a time. However on the negative side for Endovenous Laser Ablation (EVLA or EVLT), the mechanical sclerotherapy catheter does not need tumescent anaesthesia and therefore is both quicker and save the patient from having multiple injections of local anaesthetic down the leg.