In spite of their menacing, ugly appearance advanced-stage varicose veins do not pose a direct threat to the health of the individual; and as such many people suffering from these twisted, bulging, ropy veins are unhappy primarily with their appearance and seek intervention on cosmetic grounds.
However, the presence of varicose veins carries the potential for very serious complications in those afflicted- not least the predisposition to blood clots and deep venous thrombosis (DVT). DVT, in turn, carries the potentially lethal risk of pulmonary embolization (PE) and the chronically debilitating post-phlebitic syndrome. The commoner consequences of progressive, untreated varicose vein disease or chronic venous insufficiency (CVI) are swelling of the ankles; leg cramps, burning and frank pain, especially later in the day and at night. With time, skin changes set in with darkening (stasis dermatitis), thickening and firmness (lipodematosclerosis) as the subcutaneous tissues harden with fibrosis; and eventually in some- a vicious cycle of ulceration and healing with more fibrosis is ushered in, which often go on for years . Naturally, seeking qualified medical opinion and treatment before complications set in is preferable!
Depending on their specific circumstances and stage of disease, there are several different surgical and non-surgical treatment options for people who are worried about the appearance of their varicose veins and/or have lower extremity symptoms and signs. Endovenous Laser Ablation (EVLA) has the advantage of being suitable for most varicose vein patients but what exactly does it entail, how effective is it – on both a medical and cosmetic level – and are there any notable complications?
What Happens During Laser Therapy for Varicose Veins?
Endovenous or Endovascular Laser Ablation (EVLA) or Laser Therapy is one of a number of alternatives to surgery for the management of varicose veins. This treatment may be known by other names owing to the branding of the laser equipment but the procedure remains essentially the same. It is suitable for the larger, straighter veins like the great and small saphenous veins.
First, the vein to be treated is mapped by duplex ultrasonography and its course is marked on the skin. After cleaning the skin with antiseptic and draped in a sterile manner, a needle is introduced through a little nick in the skin and into the culprit vein under local anesthesia, guided by ultrasound. Upon confirming correct placement by seeing a flash of blood coming back, a floppy guide-wire is inserted through the needle into the vein, again monitored by ultrasound. The needle is replaced with a catheter, over the wire, which in turn is replaced with a longer J-wire. Over that, the longer catheter is inserted and positioned at the desired locality. The wire is finally replaced with the laser fiber, whose position is again confirmed with ultrasound. Tumescent (local anesthetic in saline) is injected around the vein under local anesthesia to cool the vein, protect the surrounding structures and eliminate any pain emanating from the heat of the laser beam.
Finally, the laser light is turned on as the fiber is withdrawn at a steady pace, allowing the laser beam to heat up the inner wall of the vein, damaging it and causing it to close and shrivel up over time. The procedure is usually painless although there may be a little discomfort as the tumescent anesthesia is injected. Upon conclusion, the laser fiber is removed and the entry site dressed, and the leg elevated. Unlike surgical removal of varicose veins, laser therapy can be performed in the comfort of an office facility with minimal or no down time- and without general anesthesia.
The Efficacy of Laser Therapy
No treatment option for varicose veins is 100 per cent successful, but EVLA is about as close as one can get. A meta-analysis of laser treatment, carried out by the Journal of Vascular Surgery in 2009, concluded that 94 out of every hundred procedures were totally effective in a lasting (closing) the target veins. The completeness of closure is operator dependent, however. But, in the unlikely event that the initial therapy fails, a second treatment may be required with or without sclerotherapy.
Further, in cosmetic terms, patients should not expect the treated veins to disappear immediately and completely. Rather, as their body gradually absorbs the closed vein, the latter shrivels up and becomes fibrous over months.
Are There Side Effects to Laser Therapy?
EVLA has been in use for over 20 years now and, over this time, has proven to be both a safe and effective means of treating unsightly varicose veins and CVI. Serious complications are very rare but there is a very small risk of developing Deep Vein Thrombosis (DVT), a potentially dangerous blood clot, or damaging an adjacent nerve or artery with the heat from the laser. Hence the attention to detail and the need to use copious tumescent and perform the procedure under local- not general, anesthesia. In fact, a DVT is more likely to occur during surgical stripping because of the stasis and the increase of hypercoagulability that accompanies major surgery.
Other potential complications of laser include burns, skin pigmentation and excessive inflammation of the venous wall; numbness, caused by temporary nerve damage, and a sensation of ‘tightness’ along the treated area. Some patients report mild pain or a tingling, burning sensation a few days after the procedure, although these are often adequately managed by over-the-counter anti-inflammatory medication.
Although no safety concerns have been raised to date about the laser devices used in EVLA, patients should be aware that newer technologies are introduced all the time and some lasers have not been around for long enough to assess their long-term sequelae.
The Spring of Youth Medical Group is pleased to offer EVLT™, an EndoVascular Laser Treatment for the treatment of varicose veins. To find out more about our range of cosmetic and venous therapies, please visit www.springofyouthmedical.com or call us on (228) 875-0885.