Chronic venous hypertension is caused when one-way valves become damaged in the veins of the legs. Blood then moves down the leg vein towards the feet instead of up toward the heart. For the largest veins, a laser is inserted into the vein which seals it closed with heat. This is termed endovenous laser ablation or EVLA.
Before scheduling the procedure, you will be evaluated for medical problems and a duplex ultrasound examination will be performed to determine which veins in your legs have damaged valves. Your physician will review these results with you and together you will decide the best course of treatment.
On the morning of the EVLA procedure, shower and eat a good breakfast with plenty of fluids. During colder months, it’s important to keep warm so the veins will be easily seen. You must have someone to accompany you and drive you home because Valium may be administered during your procedure to help relax you and open your veins. You will lie comfortably on a slanted surgical table equipped with a heating pad with your head higher than your legs. You may request a music CD to relax you during the procedure.
The physician will perform the laser procedure under strict sterile conditions. Your legs will be cleaned to maintain sterility and covered with a sterile drape. When introducing the laser, you will feel a needle prick in your leg, much like having blood drawn from your arm. After inserting the laser into your leg vein and checking its position with ultrasound, your vein will be treated with local anesthetic so you do not feel the heat of the laser. After this, the laser will be turned on and slowly pulled out as it is sealing the vein closed. The entire process takes about 20 minutes and is very comfortable.
After the procedure your leg will be bandaged and your compression stocking will be applied. It is strongly recommended that you walk for 30 minutes after the procedure and each day afterward to prevent blood clots from forming. You are expected to wear the compression hose for 2-3 weeks after the procedure.
You will be checked with ultrasound one week after your procedure to ensure that the vein has remained closed and that no blood clots have formed.
If you have more than one vein requiring treatment, these will be treated on subsequent days. When all the large saphenous veins have been treated with EVLA, the remaining tributary veins will be treated with foam sclerotherapy. In this way, by treating the largest veins first, the smaller veins and spider veins may clear up without specific treatment.
Ultrasound examinations are scheduled a month, three months, six months and a year after treatment to ensure continued success. If additional veins begin to fail, it’s best to treat them as soon as they are detected to keep you symptom-free.