Endovenous Laser Treatment

What are varicose veins?

Blood vessels encompass arteries, arterioles, veins, and capillaries and carry the essential oxygen to the tissues. While arteries carry the oxygen-rich blood from our heart to the tissues the varicose veins ensure the carriage of carbon dioxide enriched blood from them. In this sense, varicose veins are a common venous disease, an inadequate functioning of the veins.

In case of varicose veins, the vascular wall abnormally thickens or expands, so it does not perform properly its function. It does not efficiently carry the carbon dioxide enrich blood. Any vein may become varicose, but it most commonly affected in the legs, thighs, and feet but may develop elsewhere.

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How do I know if I have varicose veins?

For many people, varicose veins and spider veins — a common, mild variation of varicose veins — are simply a cosmetic concern but for others can cause aching pain and discomfort. Sometimes it can lead to more serious problems as well. They may also be signal a higher risk of other circulatory problems.

Varicose veins may not cause any pain but have signs you may have with varicose veins, including veins that are dark purple or blue in color, and veins that appear twisted and bulging, often like cords on the legs.

Swelling of the ankle and foot, especially at the evenings
Pain, sensitivity, and heaviness in the legs
Visible, lumpy veins
Cramps in the lower leg
Itchiness and edema
Injuries that occur on the affected leg bleed more and heal slower
Discoloring of the skin

If you leave it untreated it could lead to:

Dry, thinned skin
Phlebitis (inflammation of the veins)
Ulcers on the leg which do not heal over time
Thrombosis

When you are experiencing the symptoms mentioned above it’s advised to seek medical attention. The sooner the problem is recognized the better the chances are for a full recovery.

Why do veins become varicose?

Varicose veins affect up to 20 % of the population since humans started walking on two feet our legs have to carry an increased amount of weight. Because of this the valves inside our veins can be damaged sooner, leading to inadequate functioning.

However other factors are associated as well with the development of varicose veins:

Gender: Women are more prone to developing this disease because the female hormones have a relaxing effect on the walls of the veins. With this increased diameter even the properly working valves can’t do their job thus blood flows backward.
Genetics: varicose veins may be partly caused by your genes, your risk of developing them is increased if a close family member has the disease.
Age: As time passes, veins start to lose their elasticity and the valves inside them stop working as well.
Obesity: overweight puts extra pressure on your veins, which means they have to work harder to send the blood back to your heart. This can put increased pressure on the valves, making them more prone to leaking.
Occupation: jobs that require long periods of standing may increase your risk of getting varicose veins.
Pregnancy: added pressure on the veins in the legs by the weight of the growing fetus and the relaxation effects of the hormones estrogen and progesterone on the vein walls contribute to the development of varicose veins during pregnancy.

How can you treat varicose veins?

The exact treatment always depends on the severity of your condition:

As lifestyle choices also play a huge part in the development of varicose veins, in mild cases it might be enough to change bad habits:
Moderate alcohol consumption, stop smoking and losing weight can work. Being overweight is especially hard on our body and veins, as more weight means more pressure.

You should avoid lifting heavy objects and standing still for a long period of time because these activities put an increased strain on our legs. When your job requires standing for a long time try to exercise your legs often.

It’s recommended not to wear heels, tight clothing or to have long hot baths.

However, if your condition is severe, surgery is the option you can choose. This eliminates the risks for complications like thrombosis, pulmonary embolism or leg ulcers. Nowadays there are different surgeries (stripping or laser) available from which your doctor chooses the one that suits you most.

You should use compression stocking in every case of varicose veins. This supports the walls of your veins.

Beside all this, you can do a lot for the health of your veins with some exercise. You can do some of them even at work: draw circles in the air with bending your ankles, imitate the movements of cycling, stand up on your tiptoes and stand back.

How does the procedure work?

At Medicover Hospital our vascular surgeons prefer laser surgery as the treatment for varicose veins because its smaller risk and faster recovery.

The EndoVenous Laser Ablation (EVLA) or treatment (EVLT) is the most modern method to treat varicose veins (EndoVenous means inside the veins). The surgery takes approximately one hour to complete.

During the surgery –based upon the location of your affected vein- you either lay prone or on your back. Your surgeon examines the veins with ultrasound to have a clear picture about the problem and the area where incision needs to be done.

The whole process is done with analgesics and if necessary general anesthesia as well so you won’t feel any pain or discomfort.

Next, your doctor injects a needle into your skin. Through this needle they can insert the laser and the camera into your vein. With the help of the laser they eliminate the problematic parts of the vein.

At the end of the surgery your doctor removes the laser and covers the pin-prick with a Band-Aid.

There’s no blood involvement which minimalizes the risks of infections and speeds up the healing process. After a few hours of observation you can leave the hospital to recover at home.

What are the benefits of the surgery?

It’s a fast, routine procedure
It can be done under local anesthesia
There are no cuts, stiches
You won’t feel any pain
There are basically no side effects of the surgery

Is surgery risky?

The biggest benefit of the procedure its safety. It comes with minimal risk and the number of side effects (pain, bruising, and thrombosis) can be reduced to zero if the doctor’s orders are taken seriously.

We suggest taking the following actions after the procedure:

Don’t overuse your legs in the next 3 to 4 days, relax as much as possible, don’t stand still for long periods or sit with your legs hanging. You should wear compression stocking up to 4 weeks to help your veins recover. After the 4 days of rest you should use your legs often but only do mild, not straining exercises. If you’re sitting try to elevate your leg to ensure the even blood flow.

Am I a good candidate for the surgery?

Before surgery –either you choose stripping or laser therapy- you will have a number of tests (bloodwork, chest x-ray) and a consultation. This helps your doctor to determine whether it’s safe for you to undergo the surgery or not.

However if you can’t stay active enough afterwards to prevent blood clots, surgery is contraindicated. During pregnancy or breastfeeding you cannot receive pain medications so you can’t undergo the procedure.

Should I choose conventional or laser therapy for my veins?

	Stripping surgery	Laser surgery (EVLA)
The complexity of the procedure	You need a consultation with an anesthesiologist. General anesthesia is given, cuts are made and stiches are needed. It takes approx. 1,5 hour	The procedure is shorter, the vein is destroyed by a laser through a needle point in the skin. There are no stiches, cuts and blood
Pain (management)	It’s either done under general or spinal anesthesia	Local anesthesia is sufficient
Risks	There are risks associated with general anesthesia, bleeding, infections, blood clots and scarring	The only risk is thrombosis which can be greatly reduced by following doctor’s orders.