What are Varicose Veins?

Varicose veins are essentially veins that have become dysfunctional for a variety of reasons.  Veins are on the return side of our circulation system, they bring blood back to the heart after it has fed our tissues with oxygen and nutrients.  Normally in the legs, for example, blood moves upwards towards the heart due to differences in pressure and more importantly, due to our leg muscles that help us "pump" the blood upwards as we walk around.  Sometimes though, the vein walls are weaker than they should be, this is inherited from your family and can occasionally be caused by some external factors such as pregnancy and trauma.  When the vein walls become weaker, they dilate and as a result, little one-way valves inside these veins can no longer keep blood from flowing back down the leg with gravity.  As a result, venous blood flow is impaired and blood will tend to sit in these dilated veins and cause aching, heaviness, cramping, swelling and many other symptoms.  At this point, it is time to see your vein specialist so you can both determine the best course of action to correct this problem. 

I have written and edited some work on Wikipedia so please have a read for some more detailed information on varicose veins and their treatments. Varicose Veins on Wikipedia.

Normal Vein, Normal Blood Flow

Too many people suffer with varicose veins, it is a very common problem.  More than 1/3 of women and 1/4 of men will suffer with varicose veins in their lifetime.  The key is that there ARE treatments that work, and work very well.  They are very safe, and also highly effective. 

For larger varicose veins, we offer a variety of treatments, including EVLT which is a way to close the vein with a laser.  This new treatment is safe, quick and pretty much painless compared to the way it used to be done, the old vein stripping procedure.  The major problem with vein stripping, besides the pain and lengthy recovery time, is that there is a high rate of recurrence of varicose veins after surgery.  This means your veins will come back!  Laser is more effective due to the techniques used that spare the veins needed for your pelvic circulation.  Why cut out all the veins when only a few are diseased, makes sense doesn't it?  This is why EVLT is superior to vein stripping surgery, you will make less doctor visits, heal quicker, have less pain and have better results.  Here is what you can expect for your EVLT procedure:

Here's What To Expect

• Your doctor uses ultrasound to map out your vein.
• Local and topical anesthetic is applied.
• A thin laser fiber is inserted through a tiny entry point (usually near the knee).
• Laser energy is delivered to seal the faulty vein.
• Your normal day activity is then resumed. In fact, walking immediately after the procedure is encouraged (just avoid rigorous activities). 

The key benefits of EVLT

• Immediate relief from symptoms
• No scars
• Only a local anesthetic is needed
• Can be performed in the doctor's office (no hospitalization needed)
• Treatment in less than an hour
• Normal activities can be resumed immediately - with little or no pain

Testimonials (from our own patients)

I was chicken for nothing! It hurt more the night before just thinking about it. - Wade

I've had Varicose veins for years. My family doctor said it was just my vanity. The pain would keep me awake at night, now I have no pain after laser surgery. I just wish i had not waited so long. - Jill

I would recommend to anyone, just happy to have it done. - Joy

Thrilled with the results, all so easy. Great bunch of people. - Gwen

Painless procedure, whereas other stripping surgeries were very painful. Very pleased with the work done. The staff is just excellent with explanation and re-assurances. - Kathy

Contact us for a Consultation

Pre & Post Procedure Patient Information

Before Treatment

1. Please eat and drink normally before the procedure – however     please avoid alcohol and caffeine-containing products.

2. Bring your support stockings with you to the clinic. Also, please bring comfortable, loose fitting clothes that can be worn over the stockings and or bandages.

3. We recommend you arrange for transportation home following the procedure.  Patients who do not receive sedation can drive their car (preferably short distances only).

The Treatment

1. EndoVenous Laser Therapy typically takes a total of one hour to perform per leg.

2. On arrival you will be asked to change into a gown – if your undergarments are high-cut these may be left on.

3. The leg to be treated will be mapped out by ultrasound by using a felt pen.

4. A pre-treatment photograph will be taken if visual symptoms are apparent.

5. You will then lie on the treatment table and a cleaning solution applied to the leg.

6. Sterile drapes will be placed around the treatment leg.

7. Local anaesthetic (“freezing”) is placed at the entry site.

8. A small incision (a few mm in size) is then made to help guide the treatment catheter into the vein.

9. A guidewire is placed through a needle into the vein. You may feel some pulling but it will not be painful.

10.A sheath (tube) will be placed over the guidewire and the correct position in the vein found using ultrasound.

11.The laser fiber will be placed into this sheath.

12.More freezing will be placed along the vein to be treated.

13.The laser then is turned on and pulled back along the vein – using heat energy to close the vein channel.  The laser is only on for 2 to 3 minutes total.

14.After the laser is removed a small bandage is placed on the skin.3

Immediately After Treatment

1. Your support stockings and or a bandage wrap will be placed around the leg to apply pressure to the treatment area.

2. We encourage you to get up off the treatment table and walk for about 5 minutes to ensure the bandages are comfortable and to promote circulation.

Following EVLT Treatment

The first 48 hours

1. Take Ibuprofen (Advil) 400mg three times per day for one week.  You may use Tylenol 500mg three times per day as an alternative.

2. The stockings and or bandage must be left on continuously.  You may remove them for a shower/bath temporarily but must put them back on afterwards.

3. You are encouraged to walk and resume normal daily activities.

4. Walk at least 30 minutes per day every day for the next week.

5. Please avoid prolonged periods of standing in place or sitting with your legs down.

6. When sitting please elevate you legs on a stool or chair.  Elevation means having your legs above the level of your heart.

7. You may apply ice packs (on top of the bandages) over the treated areas – we recommend 15 minutes every one to two hours only if needed.

8. Drink plenty of fluid/ non-alcoholic beverages to avoid dehydration.

48 hours to one week

1. Wear your stockings 24-hours per day only removing them for showers/baths.

2. Bruising along the treatment site is normal and can be minimized by wearing the stockings continuously.  The bruising usually clears within one to two weeks.

3. The varicosed veins should be smaller.  Do not be discouraged by persisting veins on the surface of the skin, as these will continue to shrink over the next few months.

4. Some tightness over the vein is normal and may feel like a “pulled muscle” – we encourage you to continue walking to reduce this tightness.  Normal activity/exercise will not hurt your treatment outcome.  Activity such as daily walking will help you heal quicker.

5. At one week you will see the doctor and can expect to be able to return to all activities including vigorous exercise at that time.

One to Eight weeks

1. Return to full activities.  Any type of sporting activity is okay.  You cannot do any damage by being physically active.  The vein will heal better with more activity.

2. The vein branches you can see on the surface of the leg will continue to shrink or disappear.

3. Commonly, we will have to treat other tributary veins coming off of the lasered vein.  These treatments will be by injection and normally a few months after your evlt procedure and time for healing has been allowed.

4. Stiffness, minor swelling or discolouration over the treated area can occur and will progressively improve.

If you have any questions, we are here to help you, so please do not hesitate to give us a call.

Frequently Asked Questions

How does the procedure actually work?

The laser energy damages the vein walls, shrinking them and thus closing the faulty vein so that the blood can no longer flow through it.

Is loss of this vein a problem?

No. There are many veins in the leg and after treatment the blood in the faulty veins will be diverted to normal veins in order to make its way back to the heart.  Your diseased veins are not functioning properly, they need to be treated/removed to restore normal blood flow.

What are the complications of this procedure?

There are potential complications with any medical procedure however the only minimal complications experienced with the EVLT Procedure have been a small number of cases of transient paresthesia (numbness).  Other more serious side effects like DVT or deep vein thrombosis are very infrequent and normally occur in individuals already predisposed to this problem.

Am I at risk from the laser?

No. You will be given a pair of special glasses to wear to protect your eyes, however this is just a precaution against accidental firing of laser energy outside the body.  This laser essentially creates heat to damage the inside of the vein, you will not be able to see any laser light at all during the procedure.

What is the alternative to this treatment?

Traditionally faulty Saphenous veins have been treated with surgical ligation and stripping. This involves at least two surgical incisions in order to tie off and pull out the faulty vein. It is usually performed under general anesthesia. EVLT appears to have lower risk; shorter recovery period, lower costs and no scarring compared with surgery.  Radiofrequency treatments are also available, but they are limited by the types and sizes of veins they can treat.  Laser is much more flexible and easy to use resulting in better patient outcomes.

Are there alternative minimally invasive treatments available?

Yes. The two common ones are ultrasound-guided sclerotherapy (injection therapy) and radio frequency electrosurgery. Injection therapy for the Saphenous vein appears to have a high recurrence rate frequently requiring retreatment. Additionally, when closing larger veins with injections you are left with painful, lumpy veins for many months that may never even close.  Laser is preferred for those large types of veins.  However it is excellent for cosmetic treatment of any visible veins remaining after EVLT.

Radiofrequency electrosurgery is more limited in the range of patients it can treat and the treatment time is longer than EVLT.

How successful is EVLT?

98+% of first time EVLT treatments are successful.  To date we have not had one case of failed EVLT in our centre.