Methods
Endovenous laser treatment is a treatment for varicose veins in which an optical fiber is inserted into the vein to be treated, and laser light, normally in the infrared portion of the spectrum, is shone into the interior of the vein. This causes the vein to contract, and the optical fiber is slowly withdrawn. Some minor complications can occur, including thrombophlebitis, pain, hematoma, edema and infection, which can lead to cellulitis.
EVLT (Endovenous Laser Treatment) has the same meaning as ELT but is a trademark name owned by Diomed and used as the name for their 910nm laser treatment unit for ELT. The 810nm laser is the original laser fibre wavelength as pioneered by Dr Robert Min of New York USA. Subsequently, various other fibres with different wavelengths have become available. The varying wavelength each aim to maximise local damage to a component of the varicose vein or the blood contained in it while minimising damage to adjacent tissues.
During the procedure, a catheter bearing a laser fibre is inserted under ultrasound guidance into the great saphenous vein (GSV) or small saphenous vein (SSV) through a small puncture. The catheter is then advanced (also under ultrasound guidance) to the level of the groin or knee crease. Dilute local anesthesia is injected around and along the vein (perivascular infiltration) using ultrasound imaging to place the local anesthetic solution around the vein, mostly in a sub-facial location. This technique derives from the Tumescent Local Anesthesia ( TLA) method long used and proven safe and effective for some methods of Liposuction. The laser is activated whilst the catheter or laser fibre is slowly withdrawn, resulting in obliteration of the saphenous vein along its entire length. The treatment, which is performed without sedation, usually takes between 1 and 2 hours and the patient walks out under his or her own power. The leg is bandaged and/or placed in a stocking that the patient wears for up to 3 weeks afterwards. Foam sclerotherapy or ambulatory phlebectomy is often performed at the time of the procedure or within the first 1–2 weeks to treat branch varicose veins. However, some physicians do not perform these procedures at the time of the ELT because the varicose veins can improve on their own as a result of reduced reflux from the great saphenous vein.
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