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Endovenous laser treatment

Endovenous laser (or varicose vein laser) treatment is an elegant and relatively un-aggressive technique, with a lower overall cost. It can be performed without scarring or time off work, and is today highly reliable, with a 90% success rate over 5 years.

 

The principle of endovenous varicose veins treatment

The endovenous laser technique involves the destruction of the walls of the varicose veins (the saphenous tunica intima) using a laser. This eliminates the reflux of blood into the varicose vein. The process of endovenous laser treatment is the same as for varicose vein surgery:

  • a consultation with the vascular surgeon,
  • a Doppler ultrasound scan of the veins,
  • a consultation with the anesthetist,
  • a pre-operative biological check-up,
  • a tumescent local anesthesia
  • same day return home.

Advantages of endovenous varicose vein treatment

Closure of the varicose vein for 3 years without scarring in 80-90% of cases. Endovenous laser treatment can be performed either:

When endovenous laser treatment is performed on its own, the patient is free to leave immediately (one hour after the treatment), with disruption to social or professional life reduced by half on average and with low levels of post-operative pain. The overall cost of varicose vein treatment is reduced (in terms of anesthetic, surgery and time off work). Indications can be broadened to include frail or elderly patients who had until now been refused varicose vein treatment.
When combined with surgery, varicose vein laser treatment (endovenous laser) is less advantageous since, although beneficial, its effects will be less striking compared with the surgeon’s direct intervention.

Undesirable side-effects of endovenous laser treatment

  • slim patients may suffer burns

  • reversible pigmentation along the path where the varicose vein is very superficial

  • brief discomfort

  • paresthesia

The endovenous laser technique

A Doppler-ultrasound scan enables a map of the varicose veins to be drawn up. Local anesthetic is administered in each area of tumefaction as with varicose vein surgery.

A 400-600µmm diameter optical fiber is inserted into the varicose vein enabling the light produced by the laser to be delivered from its tip.

This emits a laser pulse of a specific wavelength of 980 nanometers. This energy is converted into heat and the internal temperature of the vessel is assessed at between 60 and 70°C.

The laser can be fired each time the probe is withdrawn from the varicose vein or it can be carried out continuously.

This leads to a complete retraction of the varicose vein then, over time, the body will “destroy” the wall of the vein.

Over the days that follow, there may be some inflammation and pain, but less than after varicose vein surgery.

Other endovascular treatments

“Closure or thermo-coagulation” seems to lead to more burning and paresthesia. The principle is the same as for laser; it consists of a probe that raises the temperature of the tunica intima to around one hundred degrees. This radio-frequency requires a longer time to heat the varicose vein and is only used on smaller veins than those treated by laser. The cost of the probe is higher than that for a laser fiber.

Sclerosis using echo-catheters or echo-sclerosis: the sclerosing substance is injected into the vein (either by needle or catheter). The position of the needle within the varicose vein is monitored using ultrasound. The substance may contain a sclerosing foam additive which appears to produce better immediate results, but any complications are not yet fully known.

Cryo-freezing: this was abandoned as the varicose vein does not retract and leaves a clot which can recreate a varicose vein when it is re-absorbed.

Conclusion

Endovenous laser treatment is an elegant, relatively non-aggressive technique that enables the destruction of 80-90% of varicose veins over a 3-4 year period.

The laser has a promising future as it has the advantage of leaving no scarring.

Endovenous laser treatment does require a highly experienced surgeon.

It is more similar to sclerosis than varicose vein surgery.

Read on: Surgical treatment of varicose veins

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endovenous laser

Endovenous laser generator

laser varicose veins treatment

The laser fiber is inserted into the varicose vein

varicose vein surgery, endovenous laser

Before and after: a 15-day laser treatment