Treatment Options → Endovascular Laser Ablation → Sclerotherapy → Microphlebectomy

What is endovascular laser ablation therapy (EVLA)?
Your doctor is recommending endovascular laser ablation therapy (EVLA) because you have venous insufficiency in one or more of the larger veins in your legs. The vein most commonly associated with venous insufficiency is the great saphenous vein and its main branches. Venous insufficiency is a condition where the vessels in the legs that are supposed to carry blood up, towards the heart, but are allowing blood to reflux (or go the wrong way) down towards to feet. This causes pooling of blood in the legs and can lead to pain, swelling, or heaviness, as well as superficial varicose veins.

Traditionally, this malfunctioning vein has been removed with a surgical procedure in the operating room. EVLA is a less invasive way to fix this problem. Rather than remove this malfunctioning vein, the vein is left in place, but closed from the inside through a tiny nick in the skin. After a short recovery period, most people report a significant improvement in their physical symptoms because EVLA eliminates the conduit for refluxing blood. The maximal benefits from the procedure are measured at 6-8 weeks. Occasionally, patients will need to have additional treatments (microphlebectomy or sclerotherapy) to treat residual veins for symptomatic or cosmetic reasons.

What are the risks of this procedure?

Bruising:

Bruising is very common in the treated leg. It may be minimal, moderate, or even extensive. It can last for 1-2 weeks but in some cases can be visible for months.

Phlebitis:

A collection of blood in the treated vein(s) can become painful, tender, or can cause some skin discoloration. This blood can be removed with a needle to speed the healing process, but it may require several visits.

Brown stains on the skin:

Sometimes iron from the blood is deposited in the skin and leaves a brown stain (hyper pigmentation). It is usually subtle and resolves over the course of a few months. Occasionally, it is darker brown and can last for several months to a couple of years.

Scars:

Visible scars are possible at the incision site(s). Though rare, these scars may appear lighter or darker than the surrounding skin when completely healed.

Incomplete Closure:

While the goal of treatment is closure of the greater saphenous vein and/or its major branches, occasionally the treated veins will not close completely. Wearing the prescriptive compression stockings as prescribed will help to insure complete closure. If there is incomplete closure, additional treatments may be necessary at additional expense to you and/or your insurance.

Residual Veins:

The goal of the EVLA is relief of your symptoms of venous insufficiency (i.e. leg swelling, heaviness, achy legs, and chronic skin changes or ulcers). There may be residual veins you can see following EVLA. If you choose to treat these residual veins, there may be additional cost to you for these adjuvant treatments as they may not be covered by, or billable to, your insurance.

Blood Clots:

While the EVLA treatment involves the superficial venous system, there is risk of developing a blood clot in the deep system (a DVT or deep vein thrombosis). While this is very unlikely, should this occur additional treatment may be necessary.

Infection:

Though unlikely, infection is possible at the incision site(s). Should infections occur, additional treatment may be necessary. Watch for signs of infection including redness, tenderness, pus, fever, nausea, and vomiting and call the Vein and Laser Center should any of these symptoms develop. During the day (9a.m. to 5p.m.) call (847) 717-3265 and after hours call (847) 695-1620.

Nerve Problems:

There are nerves that are occasionally irritated during the treatment. You may experience a brief twinge of pain or tingling if this occurs.Though rare, there is a risk for permanent sensory (touch) or motor nerve damage from the EVLA procedure.

Allergic Reactions:

Occasionally local allergies (i.e. skin irritation from tape or skin cleanser) or systematic allergies (involving multiple organ systems) may occur in response to drugs or chemicals used during or after your treatment.

No Relief of Symptoms:

There are many causes of leg pain, swelling, and skin changes and there is no guarantee that this EVLA procedure will completely correct the symptoms you are experiencing.

Will my insurance pay for EVLA?
Most insurance companies will cover expenses for venous insufficiency and varicose veins. Because this treatment can sometimes be considered cosmetic by the insurance industry, we will submit documentation to your insurance company prior to treatment to assure that EVLA is a covered benefit. Once we have confirmed coverage for you, we will proceed with scheduling your procedure.

What are my pre-procedure instructions?

1. Fill any pre- or post-procedure medication prescriptions you may have gotten and be sure to get your compression stockings You can get your compression stockings directly from the Vein and Laser Center. You will be measured at the time of your initial consultation (well in advance of your procedure) as the correct size often has to be ordered for you. Please also try your stocking(s) on prior to your procedure to be sure they fit. They will be very snug, but they ought to be long enough to come to the middle of your thigh.
2. To decrease bruising, avoid aspirin, ibuprofen, and vitamin E for five days prior to your procedure. If another health care provider has prescribed these medications, please get his or her permission prior to stopping them.
3. You may eat, drink, and take all normal medications (except medications mentioned above) prior to your procedure. However, avoid caffeine and try to be well hydrated on the day of your procedure.
4. The pre-procedure medications can sometimes make people sleepy, so we advise that you have someone with you to drive you home after the procedure.

What can I expect the day of my procedure?
After you have had the opportunity to have all your questions answered and have signed a consent form, you will lie on a procedure table and your leg will be prepped with a cleaning solution and wrapped in sterile towels.
After numbing your skin with a local anesthetic, the doctor will make a small (1/4 inch) nick in the skin and then use an ultrasound machine to place a very small catheter into the problematic vein. Since the blood vessels do not have sensation (touch), most patients do not feel the catheter. After placing a laser fiber inside the catheter, the doctor will completely anesthetize the area around the entire length of the vein by injecting the local anesthetic with a small needle. The laser is then activated and pulled back – closing the vein as it passes. Occasionally, patients will feel a short pinch or twinge of pain when the laser is activated, but most patients feel nothing. Be sure to let the doctor know if you have any pain or are uncomfortable during the procedure.

Your leg will be cleaned again and dressings will be placed over the small incision(s) and the injection sites. After getting your compression stocking(s) on, you will be able to walk out of the procedure room and go home. While every patient’s procedure is a little different, most EVLA procedures (including prep and clean-up time) are about 1 to 2 hours.

What are my post-procedure instructions?
For the first 24 hours after the procedure most people rest and relax. However, complete bed rest is not necessary or encouraged. Try to elevate your legs when you are sitting for the first 24-48 hours after your procedure. You can otherwise carry on with all of your normal daily activities with a few exceptions:

• No heavy lifting (greater than 15-20 pounds) for 2 weeks. Keep in mind that items like grocery bags, trash, laundry baskets, and children can weigh more than this.
• If you exercise regularly, please consult with the physician performing your procedure about your return to exercise activity. Wait at least one week before resuming heavy exercise (i.e. weightlifting, uphill biking). Regular activity can be resumed the next day. Judge this according to how you feel.
• No tub baths, swimming, or soaking in water for two weeks after the procedure to prevent infection. Taking a shower is OK.

Compression Stockings

• Wear the compression bandages continuously for 48 hours.
• Remove compression bandages after the 48 hours. You may take a shower. Put the compression hose on and wear them when you are up and around. Do not sleep in the compression hose.
• Wear the compression hose while you are up and around for three weeks. You do not have to sleep in them.

REMEMBER: You can wear the stocking(s) too little, but not too much.

Dressing Care

Leave all dressings and compression stocking(s) on for 48 hours after your procedure. You can then remove everything, with the exception of the steri-strips, and shower. (Steri-strips are white or brown and are placed directly on the skin, under the bulky dressings – much like a Band-Aid). Leave the steri-strips on for up to seven days. It is OK if they fall off sooner than that. After you have dried your leg completely, put the compression stocking(s) back on.

What can I expect as I recover from my procedure?
The following are normal and expected signs or symptoms after your procedure:

• Bruising, sometimes quite extensive, along the length of the treated vein. The bruising can sometimes be painful as well, but will improve as the bruising improves.
• Oozing of clear to pink liquid from injection sites is normal. This is some of the anesthetic solution the doctor injected and it will stop oozing about a day after the procedure or sooner.
• Tightness or stiffness (often described as a “pulled” sensation) along the treated vein can sometimes be felt about a week after your procedure. This is normal. You may feel a “cord” (like a pencil) under the skin in this area as well. It can feel quite tender and even look red. This is normal. It is in the vein that was treated in the EVLA procedure. This tightness and pain usually peaks at about 7-10 days after the procedure and then improves. You can apply warm compresses to the area twice a day, elevate the leg when sitting, and take Tylenol in addition to the Motrin or Dorvocet you have been prescribed. Call the Vein and Laser Center if you have any questions or concerns.
• Painful varicosities can persist after the ablation procedure – particularly if they were large and tortuous prior to treatment. During your recovery, these veins may feel tender, warm, and appear red. This is phlebitis and is treated via the same measures mentioned above (leg elevation, Tylenol, and warm compression). Call the Vein and Laser Center with any questions or concerns.

The following signs or symptoms may be signs of a more serious problem. While rare, please call the Vein and Laser Center (or report to local emergency department if after hours), if you develop:

• Fever, chills, nausea, or vomiting
• Pus draining from incision sites on the leg
• Redness extending beyond the incision sites on the leg
• Leg swelling and difficulty walking

Follow-Up: Patients return for a follow-up appointment about three to four days after the procedure – sooner if there are problems or concerns. We encourage everyone to return for their follow-up visit even if you are feeling great and especially if you are not. Though uncommon, occasionally patients will have residual pain but we can usually resolve this problem.