Varicose Veins: Endovenous Laser Treatment

Core Messages

Endovenous laser ablation (EVLA) has been developed as an alternative to surgery of the great saphenous vein and short saphenous vein in an attempt to reduce morbidity and improve recovery time.

EVLA can be performed in an outpatient special procedure room in a hospital.

EVLA works by means of thermal destruction of venous tissues. Several wavelengths can be used: 810, 940, 980, 1,064, 1,320, 1,470, and 1,500 nm.

Heating decreases with tissue depth as absorption and scattering attenuate the incident beam. Consequently,  the  laser  beam  must  heat  the 

vein wall and not the blood

Before  EVLA  is  performed,  the  vein  lumen must be emptied of its blood by using leg elevation  (Trendelenburg  positioning),  manual

compression, and infltration with perisaphenous subcutaneous tumescent saline solution.

The  appropriate  linear  endovenous  energy density (LEED) must be selected as a function of the diameter of treated segment. Veins larger 

than 9–12 mm in diameter are diffcult to treat, even when using higher energy.

In  a  general  manner,  side  effects  are  energy dependent. LEED more  than  100  J/cm  is  very often associated to superfcial burns and palpable indurations.

                                               

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