Endovenous Laser & Ultrasound-Guided Foam Sclerotherapy
Varicose veins are a very common condition affecting almost 30% of the adult population. They result from weakening or stretching of the valve ring or valve support in the superficial veins. The valves consist of two membranes (cusps) that normally come together or close when blood falls back down the vein. When the valves cease to function normally, blood falls through the valve (reflux) and we say that the valve is "incompetent". Because the vein is not emptied, the pressure within it increases and remains much higher than it should be. The vein walls which in most patients with venous disease are inherently weak stretch and the vein enlarges. These enlarged veins may look like a knotted rope or cluster of bubbles just under the skin and are called varicose veins.
Varicose veins may be treated as an outpatient using a combination of techniques.
Endovenous Laser Ablation (EVLA) is a minimally invasive technique used to eliminate large varicose veins. It uses laser energy which is highly concentrated beam of light that is delivered to the targeted tissue without affecting the surrounding tissue. At Kuring-Gai Vascular Ultrasound (KVU) it is performed as an outpatient procedure using local anaesthetic. Throughout the world, EVLA is rapidly replacing conventional "stripping" operations as the treatment of choice for varicose veins. Endovenous laser ablation is performed by a vascular surgeon with the assistance of an experienced vascular sonographer and patient care is managed by highly experienced registered nurses.
Through a needle puncture and with the aid of ultrasound, a laser fibre is introduced into the main superficial vein in the inner thigh or the calf. The laser is activated and the fibre is slowly pulled back along the vein. Intense energy produced at the tip of the fibre seals-off the varicose vein and in the following months the vein contracts completely so that only a small fibrous thread remains. EVLA has been available in the USA since the late 1990's and in Australia for almost 10 years. At KVU we use the latest technology, incorporating a 15 Watt laser system (1470 nm wavelength) and radial-firing laser fibre manufactured by Biolitec (www.biolitec.com).
The procedure is performed under local anaesthetic and takes between 1 ½ and 2 ½. After this treatment the patients will be allowed to return to home the same day and can resume their normal activities. Endovenous laser treatment can have side-effects including bruising, discoloration and inflammation. These are temporary and usually resolve after few weeks.
The term sclerotherapy refers to the use of a chemical (sclerosant) that is injected into an abnormal vein (varicose vein) resulting in inflammation that causes the vein to collapse (spasm) and over time the vein shrinks and is absorbed by the body leaving a thin fibrous chord in its place. Varicose veins have traditionally been treated by surgery, but since the early 1990's the technique of directly injecting larger veins using ultrasound to guide the doctor has become popular. This technique, ultrasound guided foam sclerotherapy (UGS) developed in Europe, has gained worldwide acceptance as an effective way of eliminating larger varicose veins. Presently, UGS is the method of choice for treating recurrent varicose veins and minor primary varicose veins. It is also used to treat varicose veins when Endovenous Laser Ablation is performed.
A liquid sclerosant is mixed with air to create foam. This is injected into the varicose vein which goes into spasm (shuts down). The sclerosant also damages the vein wall setting up an inflammatory response and over the next 24 hours the vein blocks-off. The treated veins remain visible but over the next 3-6 months then shrink away. One to six injections are performed per session and depending on the number and size of the abnormal veins, on average 2 treatment sessions are required.
Both EVLA and UGS have significant advantages over traditional stripping operations:
- Walk in, walk out outpatient procedures
- Local or no anaesthetic
- No large/multiple incisions
- No scarring
- No nerve damage
- No lymphatic damage
- Minimal discomfort post-treatment – little or no analgesia is required
- Minimal bruising
- Immediate return to work
Side-effects of EVLA and UGS may include:
- Short-lived aching or cramping flowing an injection
- Minor bruising
- Tender lumps and inflammation
- Brown lines or discolouration
- Temporary numbness
- Development of new blood vessels at the site of injection
The majority of side-effects indicate that the treatment is working may last from a few minutes to a number of weeks. All will resolve over time.