Treatments for Veins and Varicose Veins - EVLA - EndoVenous Laser Ablation of Varicose Veins
Endovenous laser ablation (EVLA) was invented following a discussion by 3 doctors at a venous meeting in 1998:
- Dr Carlos Boné from Spain
- Dr Luis Navarro from the USA
- Dr Robert Min from the USA
(Endovenous laser: a new minimally invasive method of treatment for varicose veins--preliminary observations using an 810 nm diode laser. Navarro L, Min RJ, Boné C Dermatol Surg. 2001 Feb;27(2):117-22 - click here to see abstract)
It had become clear that heating a vein with sufficient energy to destroy it, cause the vein to shrivel away and cause a permanent closure. Therefore the vein did not need to be removed - closing it gave the same result.
Both stopped the refluxing flow of blood back down the vein, therefore both stopped the damage that caused varicose veins and the complications of itching, thrombophlebitis, venous eczema, red and brown staining of the skin, bleeding and leg ulcers.
Mark Whiteley explains EndoVenous Laser Ablation of Varicose Veins
Initially EVLT® was the only technique that allowed laser to be introduced into the vein to destroy it. However, many other companies have now produced different laser techniques to do the same job, using different wavelengths of laser, different introduction of techniques and even different ways the energy is fired out of the end of the laser fibre.
Therefore, although some people still use the term EVLT® to mean laser treatment of varicose veins, in fact EVLT® is a registered trademark that only refers to one product. It is much more correct to use the term EVLA - endovenous laser ablation - when talking about the different techniques that are available.
Although there are different techniques of performing EVLA, the general principles are the same for all different techniques.
Using Duplex Ultrasound, a needle is passed into the vein under local anaesthetic. A wire is passed up the vein, once again under ultrasound control to make sure it is in exactly the right place.
A long sheath (like a very long biro refill) is then passed up over the wire - a technique called the "Seldinger technique".
When the vein is destroyed, the inside the vein can reach 700°C although the outside is usually much cooler than this. However, to prevent any pain and to stop any heat burning any surrounding tissues, a very dilute solution of local anaesthetic and normal saline is injected around the vein. Ultrasound is used to make sure it is in exactly the right place. This is called tumescent anaesthesia.
Mark Whiteley performs EndoVenous Laser Ablation of Varicose Veins
The laser fibre can now be passed up inside the sheath. It was research from The Whiteley Clinic that showed that it was important to put the tumescence in before passing the fibre up, to make sure the fibre was not damaged by the anaesthetic needle. This research was one of the many prizes won by The Whiteley Clinic in the development of these techniques.
Once the ultrasound shows the laser fibre is in exactly the right place, the laser is fired and the sheath and fibre is pulled down at exactly the right speed, closing the vein at a precise energy level. Research is showing that 60 - 80 Joules per cm of vein will destroy the vein but will cause minimal pain and bruising.
Using EVLA in the veins identified as being suitable by Whiteley Clinic protocols, using The Whiteley Clinic techniques, allows us to permanently destroy appropriate veins using one pinhole incision for each vein.
Our research has shown that the best results come from treating not only the main vein, but in at least a third of people we need to treat at least one additional vein.
There are new EVLA procedures coming, and The Whiteley Clinic is involved in research with some and is trialling others to make sure that we keep offering patients the very best available treatments.
Unlike stripping, our EVLA procedures have never shown any re-growth of veins even after five years. You can contrast these results with the re-growth found after one year on the vein stripping part of this website.
EVLA in suitable patients really allows true walk-in walk-out varicose vein surgery, and when combined with other appropriate techniques gives us the excellent results that our patients require.
