Endovenous Laser Ablation
Endovenous laser ablation, also known as EVLA, is a minimally invasive alternative to the traditional ligation and stripping treatment of varicose veins. Varicose veins are a common medical condition involving diseased veins, usually in the leg. As blood pools in the legs, the walls of the veins distend, until the veins appear raised and twisted under the skin. For some individuals, varicose veins present only a cosmetic problem. If the condition worsens, however, varicose veins can become painful and even dangerous and medical intervention may become necessary.
During the EVLA procedure, the skin is numbed with local anesthesia, and a tiny laser fiber is inserted into the skin and guided to the saphenous vein through ultrasound imaging. The saphenous vein is the large superficial vein carrying blood from the lower body back to the heart. Once the laser fiber is inserted, the vein is surrounded by a small amount of liquid and exposed to the laser energy. The laser energy causes the vein to be sealed off and diverts blood flow to healthier surrounding veins.
Sclerotherapy is a minimally invasive medical procedure used to treat varicose and spider veins, most commonly found on the legs, by collapsing them through the use of a solvent. Sclerotherapy has been used on patients since the 1930s with great success, producing increasingly effective medical, as well as cosmetic, results.
During sclerotherapy, a solution of saline and a sclerosant is injected into the damaged veins. This will cause irritation in the affected veins and produce their eventual collapse. During this procedure, the surgeon is guided through the use of ultrasound to ensure precision. When the weakened veins collapse, they will be reabsorbed into the body and other healthier veins will take their place in the circulatory system. The procedure usually takes less than an hour, but the patient may require more than one treatment. Some bruising is to be expected after the procedure, but usually resolves quickly.
An ambulatory phlebectomy, also called a microphlebectomy or stab phlebectomy, is an outpatient procedure performed to remove spider and varicose veins through small, slit-like incisions in the skin. When varicose veins near the surface of the skin are too large to treat with sclerotherapy and too small to treat with laser ablation, microphlebectomy is the preferred treatment. Since veins are extremely collapsible, even the largest affected veins can often be removed through tiny incisions using the ambulatory phlebectomy procedure.
The ambulatory phlebectomy procedure is performed on an outpatient basis. This procedure takes about 45 to 60 minutes to perform. There are several steps involved in the procedure:
- Marking the veins to be treated- The doctor will first identify the veins to be treated to ensure precise removal and to help preserve the health of surrounding veins and tissue.
- Administering a local anesthetic- Before beginning the surgery, the doctor will inject a local anesthetic into the skin. Patients generally do not experience any discomfort during the procedure.
- Making incisions- Tiny incisions will be made in the targeted areas, and a surgical hook will be inserted to extract the damaged veins section by section. The incisions are very small and frequently no stitches are required. Veins are very collapsible such that even large veins may be removed through the tiny incisions used in this technique.
- Applying compression bandages- The patient will be required to wear compression bandages for a week after surgery to help minimize swelling and discomfort.
An arterial doppler is a non-invasive diagnostic test performed to evaluate blood flow in different areas of the arms and legs. Doppler technology uses sound waves to identify differences in blood pressure in various areas and to help diagnose narrowing or blockage of major arteries.
During the arterial Doppler procedure, blood pressure is taken with a cuff at various points along the arms and legs. While these readings are being taken, a handheld device called a transducer is moved across each area. By measuring changes in pitch through ultrasound, the transducer detects variations in blood flow before and after the cuff is inflated, producing images of them on a screen for the doctor to examine.