Endovenous Laser Ablation

Our clinic introduced EVLA to Sydney, New South Wales and our doctors were the first practitioners in Sydney who performed this procedure. EVLA is the latest and most effective treatment for large varicose veins . The treatment involves using Endovenous catheterisation under Ultrasound guidance for the introduction of a fiber-optic laser which ablates the vein as it is withdrawn.

This is a sterile procedure performed in our operating rooms and only takes 60 minutes to complete. It does not require general anaesthesia as it is performed under local anaesthetic. A 5 year success rate of 90% to 93% has been reported. Side effects are very limited and rare.

Endovenous Laser Ablation (EVLA)

Endovenous laser ablation (EVLA) or therapy (EVLT) is a breakthrough in the modern management of varicose veins. This technique has been used to treat varicose veins since 1999. Dr Parsi was the first practitioner to perform EVLT in Sydney, Australia.

Endovenous laser treatment uses laser light energy to seal off large vessels such as large veins. It is also used to treat vascular malformations. When treating varicose veins, EVLA is used to seal off the incompetent (abnormal) saphenous veins. Saphenous veins are the main superficial veins of the legs. Please note that saphenous veins are NOT deep veins and when they stop working, they can cause a lot of damage to the legs. This damage may appear as swelling, itching, pain, skin darkening (pigmentation), eczema, hardening of the skin and fat (lipodermatosclerosis) and eventually ulceration. A lot of these can be prevented when the abnormal saphenous vein is removed or sealed off.

Surgical stripping is one method of removing this abnormal vein. Ultrasound Guided Sclerotherapy (UGS) and EVLA are other techniques that seal off the vein. EVLA involves a combination of laser and ultrasound technology and does not require admission to hospital or general anaesthesia. Research performed on more than 1000 patients has shown a low risk of complications and superior results when compared with surgery and UGS (excellent results in over 90% of patients). EVLA is used to treat the main trunk of the saphenous vein. If branch veins are also abnormal, UGS may be required to treat them.

EVLA PROCEDURE

At Sydney Skin and Vein Clinic, we use a local anaesthetic cream to numb the leg before the procedure. We use disposable laser fibers for this procedure. Despite this, at Sydney Skin and Vein Clinic the cost of the procedure is not more than clinics where a re-usable fiber is used. The procedure is done in a sterile fashion, and the doctor and the assistant sonographer scrub for the procedure. The doctors are also assisted by a scout nurse.

A local anaesthetic injection is used near the ankles and a small needle is positioned in the target vein. The vein is then accessed via a guidewire and then a catheter (line). The laser fiber is then positioned in the catheter. Anaesthetic solution is then injected around the target vein. At this stage, the laser is activated and as the laser fiber is pulled out of the vein, the vein is sealed off. The bottom section of the vein is injected using the same catheter that is already in the vein.

Compression stockings and bandages are then applied and the patient is sent for a walk. The patient is reviewed within one week. Tributary veins are treated with UGS.