What is and how is the treatment of varicose veins laser

Author Ольга Кияница


In the early stages of the development of varicose veins, conservative treatment is most often used, which includes taking tablets of drugs and applying ointments to the affected areas of the body. In severe cases, resorted to the removal of veins. For this purpose, laser varicose vein treatment is widely used today. With its successful implementation, the general well-being of the patient improves markedly.

Treatment of varicose veins with a laser is also known as endovasal laser ablation (EVL) or endovascular laser coagulation (EVLK). Since its introduction, it has replaced such procedures as ligation and removal of veins in an open way. Often used to eliminate venous reflux.

For the first time in phlebology, a laser was used in 1981 by Anderson RR and Parrish JA For this, dyes with a wavelength of 577 nm were used. Under his influence, the small vessels of the skin were damaged (according to wikipedia.org).

The endovascular method is safe, well tolerated and gives a long-term result. In addition, it was shown that it is associated with less severe post-procedure pain. This reduces the recovery of the patient, thereby ensuring his earlier return to normal activities.

Video: Endovenous Laser Coagulation Procedure

Description of endovenous laser ablation

Endovenous laser ablation (EVL) is a minimally invasive procedure that is widely used to treat varicose veins. During its implementation, a laser fiber is used, placed inside the varicose vein. This causes the closure of the vessel under the influence of thermal energy. Usually laser treatment is carried out in combination with ultrasound sclerotherapy. In such cases, there is a sonographer, who provides the entire process of ultrasound.

With the help of endovenous laser ablation, large varicose dilated veins are most often treated, while during the procedure a slight discomfort is felt.

The mechanism of EVL

The main impact factor - the energy of laser radiation - contributes to the destruction of the endothelium. This is due to the laser heating the blood in the vessel, resulting in the formation of vapor bubbles. They affect the inner wall of the vessel (endothelium), which leads to its damage.

The outcome of laser treatment largely depends on the quality of the destruction of the endothelium. If the laser failed to destroy all endotheliocytes, then in the presence of viable islets, it is possible to restore the vessel and blood circulation.

Avoidance of vessel reconstruction is possible with sufficient energy density supplied by a laser into the vessel lumen. At the same time, the endothelium begins to "char", which contributes to an even more active absorption of thermal energy.The only excessive heating of the wall of the vein can lead to its perforation. This in turn leads to pain after the procedure.

Laser light guides of the last generation to the maximum prevent the development of such undesirable consequences.They have a wavelength of 1.47 µm, which leads to a more active absorption of heat by the blood and the wall of the vessel. As a result, the venous wall is less heated, and carbon is formed in a smaller amount at the optical fiber and the radiation power is reduced. All this allows patients to feel better after the operation.

Varicose Veins. Endovenous Laser Treatment. laser fiber is inserted into the vein through a tiny incision. The catheter

Technique performance EVL

The procedure is based on the sequential passing of five stages:

  1. A light guide is inserted into the main venous vessel after the puncture.
  2. The working part of the fiber is installed in a certain position.
  3. The patient is given a tumescent anesthetic.
  4. Directly performing laser ablation of the vein.
  5. Applying pressure bandage.

The procedure can take an average of 90 minutes, in simple cases - 50-60 minutes. If the coagulation is successful, the patient can leave the clinic on the same day. In the future, monitoring the patient's condition is carried out on an outpatient basis. After treatment, the daily life of the convalescent person is not significantly disturbed, however, heavy physical exercise or exercise should be avoided for about 2 weeks after each treatment. It is also recommended to wear compression stockings after treatment.

Instructions for patients in the postoperative period

  • Day 0 (day of treatment) until day 3 : Compression tights should be worn day and night. You should not take a shower if you do not use waterproof protective equipment on top of the stockings.
  • Day 4 - Day 7 : You can take off the stockings for a quick shower, and then put them on again.
  • Day 8 - Day 14: Wear compression clothing during the day. It is best to wear stockings in the morning before the legs are out of bed.

Answers to frequently asked questions

What are the indications for laser treatment of varicose veins?

There are situations in which treatment of varicose veins with a laser is recommended first of all.

  • Varicose veins of the great surface . The size of the vessel should not be more than 10 mm. Larger veins can also close EVLA, but then the risk of an unsatisfactory result increases.
  • The presence of a small number of varicose tributaries . Otherwise, the volume of the operation increases several times and then it is better to perform stripping.
  • The course of a trunk of a big or small superficial vein has to be equal . Sometimes the vessel makes a bend, which is almost impossible to pass through any conductor. Then either two fibers are introduced from below and above the bend, or another type of therapy is prescribed.
  • The presence of trophic ulcers on the legs . For the treatment of this pathology there is a special kind of laser treatment - endovasal obliteration of perforating veins with a laser. Using this technique, horizontal reflux is eliminated, while the reliability of this type of operative exposure is as guaranteed as with endoscopic dissection.

What are the contraindications for treatment of varicose veins with laser?

There are two groups of contraindications, general and local. The latter include the presence of inflammatory foci at the site of the operation and a significant expansion of the large superficial vein.

General contraindications are as follows:

  • Thrombophilia . Some patients have a tendency to form thrombosis, and this threatens with deep vein thrombosis and pulmonary thromboembolism.
  • Ischemia of the lower extremities, which occurs in a chronic form . After laser ablation, a compression bandage is necessarily applied, and this may aggravate the course of the existing ischemia.
  • The advanced stage of obesity , due to which it is not possible to properly apply pressure bands.

Also, if there is a primary disease that requires immediate treatment, EVA may be delayed or not used at all.

Video: Laser varicose vein treatment - contraindications

What are the side effects and complications of laser treatment?

Side effects and complications of EVLA can be specific to laser coagulation and common, which occur with other similar types of treatment.

  • Superficial phlebitis and deep venous thrombosis

Superficial phlebitis or inflammation of the vein may occur after ablation, and the patient is determined by redness, warmth and pain over the treated area. If you experience these symptoms, you should immediately call your doctor.Sometimes what looks like phlebitis is a sign of something more serious. For example, it may be deep venous thrombosis. This pathology occurs during the progression of phlebitis, due to which a thrombus (thrombophlebitis) is formed in the system of deep veins.

Wearing compression underwear and walking helps prevent blood clots from forming and reduce swelling. In the presence of phlebitis, even before treatment of varicose veins, a laser will need to bring compression stockings for use as a dressing after the procedure. Often, ibuprofen and simple home remedies, such as lifting legs up and putting on ice, help alleviate the temporary discomfort associated with phlebitis.

  • Neurological thermal injury

Some patients experience a prolonged neurological injury after EVL. Paresthesia and dysesthesia are two neurological sensations that most often occur with this complication. Paresthesia is a tingling or numbness, similar to a flowing arm or leg due to being in one position for a long time. People with diabetes often experience dysesthesia, an abnormal sense of touch or unpleasant sensation.

Trauma to the sensory nerves can occur with the introduction of a fiber, conducting anesthesia, or simply because of the strong heat. Yet nerve damage is more often associated with phlebectomy or venous surgery than with minimally invasive procedures, such as EVLA. Studies show that tumescent anesthesia reduces neurological thermal damage, acting as a protective agent and cooler to surrounding areas.

  • Burning skin

During EVL, high heat energy is generated, which can cause skin burns. Nevertheless, many experts in modern clinics use methods and devices based on anesthesia, which reduce the likelihood of this complication. In particular, the reduction of stored energy and the introduction of a tumescent anesthetic contribute to the reduction of thermal damage to the skin.

Simple measures, such as changing the laser mode from continuous to intermittent radiation, limit the exposure time to the skin by direct heating. Tumescent anesthesia is anesthesia and protection against burns due to the operation of the device, which allows for effective contact of the vein wall and adjacent insulating structures.

Nevertheless, if EVL is successful, then the patient feels much better, and the result of the procedure sometimes speaks for itself.

Do varicose veins need to be preserved?

Varicose veins, reticular and spider veins, damaged against the background of varicose veins, cease to function properly. As soon as the veins become abnormal, the body finds alternative ways of passing blood through healthy vessels. Thus, it is not necessary to think that after ablation it will be possible to remain without veins. On the contrary, the work of the venous system improves markedly without them.

Will laser-removed varicose veins return?

As noted above, it all depends on the quality of the ablation performed. Properly treated veins will not be able to recover, because after six months they turn into connective tissue strands. However, new veins may appear over time. How quickly and how many of them will depend on whether the disease is inherited and whether preventive measures are taken. Other factors, such as the initiation of hormonal drugs, pregnancy, or long-term sports activities, can affect the development of abnormal veins.

What can be expected after treatment of varicose veins with laser?

In order for minimally invasive surgery to be successful, it is important to observe the following guidelines:

  1. You need to consult with your doctor about any activities related to travel, so that treatment is scheduled for the most convenient period of time.
  2. Immediately after the procedure, you need to walk about 30-40 minutes, this will prevent the development of deep vein thrombosis.
  3. The next 2 weeks will also need to walk every day for at least 30 minutes. Walking minimizes the risk of deep vein thrombosis.
  4. If possible, you should often raise your legs.
  5. Sharp and excessively stressed movements (such as jogging, aerobics or weight lifting) should be avoided during the first 2 weeks.
  6. Easy or moderate exercise and activities such as golf or any light bike ride are allowed.
  7. As a rule, you can continue your regular work if the doctor has not recommended something else.
  8. It is necessary to remove or change to another size compression underwear, if it causes discomfort in the leg during sleep. After lifting the bed, the stockings should be put on again. No need to cut stockings, but rather go to the clinic to solve the problem.

If there are any serious symptoms, such as tenderness or swelling of the lower leg, shortness of breath, chest pain, or other breathing problems, this may be due to deep vein thrombosis. In such cases, you must immediately go to the hospital for a prompt examination.

After treatment with laser varicose veins, patients may experience some pain and heaviness in the legs, especially during the first few days after the procedure. Similar signs become more noticeable at night. If endovenous laser therapy has been used, then after treatment some discomfort may occur in the inner part of the thigh. If this is a concern, you can take paracetamol or ibuprofen (but not earlier than 48 hours after treatment). You can also use a local anti-inflammatory gel, such as voltaren, if necessary.

Video: Cost of laser obliteration of the lower extremity veins

Source 1. Khilnani NM, et al. (2010). Multi-society consensus quality improvement guidelines for the treatment of lower extremity superficial venous insufficiency with endovenous thermal ablation from the Society of Interventional Radiology, Cardiovascular Interventional Radiological Society of Europe, American College of Phlebology, and Canadian Interventional Radiology Association. Journal of Vascular and Interventional Radiology, 21(1): 14–31. 2. Van den Bos R, et al. (2009). Endovenous therapies of lower extremity varicosities: A meta-analysis. Journal of Vascular Surgery, 49(1): 230–239. 3. Endovenous Laser Varicose Vein Surgery. The Johns Hopkins Hospital, and Johns Hopkins Health System https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/endovenous-laser-varicose-vein-surgery

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