Endovenous laser treatment

Endovenous laser treatment (EVLT) is a minimally invasive ultrasound-guided technique used for treating varicose veins using laser energy.

Methods

During the procedure, a catheter bearing a laser fibre is inserted under ultrasound guidance into the great saphenous vein (GSV) or small saphenous vein (SSV) through a small puncture. The catheter is then advanced (also under ultrasound guidance) to the level of the groin or knee crease. Dilute local anaesthetic is injected around and along the vein (perivascular infiltration). The laser is activated whilst the catheter or laser fibre is slowly withdrawn, resulting in obliteration of the saphenous vein along its entire length. The treatment, which is performed without sedation, usually takes between 1 and 2 hours and the patient walks out under his or her own power. The leg is bandaged and/or placed in a stocking that the patient wears for up to 3 weeks afterwards.Foam sclerotherapy or ambulatory phlebectomy is often performed at the time of the procedure or within the first 1-2 weeks to treat branch varicose veins. However, some physicians do not perform these procedures at the time of the EVLT because the varicose veins can improve on their own as a result of reduced reflux from the great saphenous vein.

Complications

Complications of endovenous laser treatment can be categorised as minor, or serious. Minor complications include bruising(51%), haematoma(2.3%), temporary numbness(3.8%), phlebitis(7.4%), induration(46.7%), and a sensation of tightness(24.8%). More serious complications include skin burns(0.5%), deep venous thrombosis(0.4%), pulmonary embolism(0.1%), and nerve injury(0.8%). These rates of complications are derived from the Australian MSAC review of all available literature on the procedure.Medical Services Advisory Committee, Endovenous laser therapy (ELT) for varicose veins. MSAC application 1113, Dept of Health and Ageing, Commonwealth of Australia, 2008.http://www.msac.gov.au/internet/msac/publishing.nsf/Content/2E0BACBB8704139ACA25745E001C2F21/$File/1113report.pdf]

Clinical evaluations

The Australian Medical Services Advisory Commitee (MSAC) in 2008 has determined that endovenous laser treatment for varicose veins "appears to be more effective in the short term, and at least as effective overall, as the comparative procedure of junction ligation and vein stripping for the treatment of varicose veins." It also found in its assessment of available literature, that "occurence rates of more severe complications such as DVT, nerve injury and paraesthesia, post-operative infections and haematomas, appears to be greater after ligation and stripping than after EVLT". A study of 516 treated veins over 69 months by Elmore and Lackey reported a success rate of 98.1%. [Elmore FA and Lackey D, Effectiveness of endovenous laser treatment in eliminating superficial venous reflux, Phlebology, 2008 ;23:21-31 ]

References