What is EVLT?

Endovenous laser treatment, also known as EVLT, is an innovative procedure that has replaced invasive surgical procedures for the treatment of larger varicose veins. EVLT involves the use of a high energy laser fiber, which administers heat directly into the affected vein. The laser heat damages the walls of the vessel, causing it to constrict and seal shut. Blood is rerouted through healthy veins nearby.

EVLT has replaced more invasive vein stripping and ligation for some patients. Instead of removing the diseased vein, the vein is treated inside the leg. Unlike vein stripping, EVLT requires no incisions, stitches or anesthesia. This results in a procedure with less discomfort and downtime, but the same positive cosmetic results.

Ultrasound imaging may be used to guide the laser fiber to the precise location inside the vein. This ensures no surrounding tissue or vessels are disturbed or damaged. Ultrasound may also be used after the procedure, to assess the success of the treatment and monitor healthy blood flow in the leg.

When is it done?

EVLT may be used on large varicose veins, including those veins that bulge and twist above the surface of the skin. Because it can be combined with ultrasound imaging, it can also be used to treat varicose veins underneath the skin’s surface. This procedure works on veins too large for effective sclerotherapy treatment, and involves less recovery time than vein ligation and stripping procedures.

Larger varicose veins often become more than a cosmetic concern. These veins may be accompanied by uncomfortable symptoms, including achiness and swelling in the legs, fatigue and the formation of painful skin ulcers. By treating the affected vein with EVLT, patients can enjoy relief from symptoms, as well as an improved cosmetic appearance.

How does the procedure work?

EVLT is performed in the office or surgical suite of a vein specialist. The procedure is usually done on an outpatient basis, using either topical or local anesthetic. Some physicians might also offer sedation to maximize patient comfort during the procedure.

The area to be treated is sterilized and marked, using ultrasound imaging to locate the site if necessary. A narrow laser fiber is then inserted through the skin and directly into the affected vein. Once it is in the proper position, laser energy is emitted from the fiber to damage vein walls and cause them to seal shut. Because the energy is released inside the affected vein, surrounding vessels and tissue are left untouched.

EVLT typically takes an hour or less to complete, particularly since only one vein is usually treated at a time. Patients are observed for a short time after the procedure, to ensure no complications arise. After this time, they are encouraged to get up and walk around, to promote healthy blood flow and faster healing. Compression stockings are typically prescribed for the same reason, and are worn for one to two weeks after the procedure.

What is the recovery like?

There is no recovery time needed after EVLT, although patients are usually advised to refrain from heavy lifting or strenuous exercise for a number of days afterward. Hot tubs, swimming pools and sunbathing are also discouraged. Most patients are able to return to regular activities, including work, the same day as the procedure.

Some mild swelling or bruising may occur around the area where the catheter was inserted. Compression stockings usually reduce this side effect and encourage faster healing. Any discomfort after the procedure is commonly treated with over-the-counter pain medication.

When will the results appear?

Results of EVLT can be seen almost immediately after the procedure. This is particularly true for patients experiencing relief from uncomfortable symptoms. The affected vein will also become less visible, usually sealing completely shut within a week after treatment. The vein is slowly absorbed by the body as blood is rerouted through other healthy veins. Over time, the vein will not even be visible through an ultrasound examination.

How many treatment sessions are needed?

EVLT effectively treats a single varicose vein in just one treatment session. However, additional sessions may be recommended if other veins require treatment. Smaller veins in the area may be addressed with additional vein treatments, such as sclerotherapy, as needed.

Will veins reappear after treatment?

Treated veins will not reappear after treatment, since they are completely closed and reabsorbed by the body. However, new varicose veins may appear over time in the same area. These veins may also be addressed through vein treatment options as warranted.

What is the cost of EVLT?

A single session of EVLT may run anywhere from $600 to $3,000. The cost varies based on the location of the doctor and the size and number of veins to be treated. Treatment for symptomatic varicose veins may be covered by insurance, particularly if less invasive treatment options are prescribed first. Physicians may also offer financing options for uninsured patients, to make the treatment more affordable.