Endovenous Laser Ablation

Q:  What is venous insufficiency?

A: “Venous insufficiency” or "reflux" is blood falling back down your legs, rather than returning to your heart.  When blood falls down in your legs, the veins become pressurized, giving aching, heaviness, throbbing, pain, itching, burning and tired legs.  Over time the veins leak fluid into the tissue, giving swelling.  Subtle swelling can be appreciated as "sock lines".  Red blood cells can be forced out into the tissue and deposit Hemoglobin as iron, staining the tissue and giving a gradient of color that is worst closer to the ground.  Insufficiency can affect your deep veins, superficial veins, and connections in between called perforators.  Here at The Healthy Vein, we take pride in doing a complete consult and mapping ultrasound to determine the cause of your leg discomfort and the location of the reflux.  Once we identify where the reflux is occurring, we can make a personalized treatment plan.


Q:  How is venous insufficiency treated?

A: “Venous insufficiency” or "reflux" of the large superficial veins in the leg, or blood falling back down the veins away from the heart, is commonly treated with ablation or heat sealing of the long straight vein.  Ablation is typically performed with heat from a laser.  The treatment for venous insufficiency with heat from a laser source is called Endovenous Laser Ablation (sometimes called EVLA or EVLT).  Laser ablation is an ambulatory procedure: you can drive yourself to and from the Healthy Vein for your procedure and go to work or back to your busy life directly from here.  Your treatment is performed in our office, without sedation, using local numbing and cold spray along the leg to minimize discomfort.  Through a small IV,  the laser is introduced to the vein for treatment.  A cushion of cold numbing fluid is placed around the vein to give you comfort during the treatment and to prevent the heat from spreading to the surrounding tissue.  After numbing, we use the laser to  seal the vein.  Your time in the office is generally 1.5- 2 hours total.


Q:  How many treatments will I need?

A:  Your mapping ultrasound is performed here at the Healthy Vein to determine your treatment needs.   An ultrasound mapping diagram will show you blood falling down toward the floor as "red" or refluxing, and the blood returning to the heart as "Blue" or correct flow. Each leg can need one or more laser treatments; however, for comprehensive treatment of your vein disease several injection treatments may also be needed to close accessory veins, varicose veins and later in the process, visible or spider veins.  We will design a personalized set of treatments to improve your symptoms and physical appearance.


Q:  Does insurance cover procedures?

A:  Most insurance providers recognize venous insufficiency as a medical condition and will cover the treatment of functional vein disease.  One of our insurance specialists will review your benefit coverage.  At The Healthy Vein, we are careful to document your vein problems and how they affect your life to optimize the chances of insurance approval.


Q:  Don’t I need all my veins? What happens to the ones that are closed?

A:  Our bodies have an amazing network of veins and even the capability to form new veins.  This network is divided into a deep venous system and a superficial venous system. The deep system is responsible for carrying the majority of blood flow back to the heart, while the superficial system shares some of this responsibility.  We only treat the major veins of the superficial system with ablation; when one of these veins is closed the blood reroutes to healthy veins, including those in the deep system.  Over time, the veins that have been sealed shrink and are reabsorbed by the body.


Q:  Do I need my leg veins for future heart bypass surgery?

A:  Veins in the legs are often used for heart bypass surgery; however, veins that are diseased from Venous Insufficiency are not generally used for this purpose.  Other healthy veins, and even arteries, are possible to use for the bypass.


Q:   Will vein treatments affect my heart?

A:  When we treat veins that are refluxing, it reduces your leg symptoms and overall improves blood flow back to the heart. The less that blood collects in your legs, the more functional you will feel as a result.  Many people start to feel less symptoms within days of the treatments.


Q:  How should I prepare for the procedure?

A:  The day of the procedure you can function as you normally would. You can eat and take your normal medications. However, if you are currently wearing compression stockings we do not require you to wear them the day of the procedure, but we do want you to bring them with you for after the procedure.  You should also wear loose, comfortable clothes since your leg will be bandaged after the procedure.  Bring your sneakers or other comfortable shoes to walk on the treadmill before and after your procedure to stimulate blood flow.  Being well hydrated is important for the success of your treatment.   To optimize your veins for the procedure we recommend:  the night before your procedure, please drink at least eight -8 oz glasses (2 Liters) of fluid.  On the morning of the procedure, please drink an additional four -8 oz. glasses (1 liter) of fluid.   Please avoid CAFFEINE – for example:  coffee, tea, soda.


Q:  Why NO CAFFEINE the day of my procedure?

A:  Caffeine dehydrates you, makes your veins smaller and more likely to spasm.  Veins that are small or in spasm cannot be treated as successfully.


Q:  How long does the procedure take to perform?

A:  The actual procedure can take anywhere from 35-60 minutes based upon your anatomy.  However, this time estimate does not include the time needed for changing into our comfortable, cloth shorts, warming up on the treadmill to get your blood moving, obtaining your blood pressure, cleaning your legs and placing sterile drapes, applying your stockings, giving care instructions and a short time on the treadmill. Therefore, we recommend you plan on being here in the office for approximately 1.5 to 2 hours.


Q:  Can I go back to work after the procedure?

A:  Most people go  back to work or other responsibilities right after the procedure.  At The Healthy Vein, our executives, teachers, hairdressers, full time child care workers, and parents go right back to life after the procedure.   Some patients even bring work to the appointment to complete on their smart phone or computer while the procedure is being performed.  You will be walking on the treadmill before you leave the office.

Q:  Is the treatment painful?

A:  Because we use cold spray and numbing medication, pain or discomfort is very minimal.  We communicate!  Knowing as much as possible and collaborating is the best way to get comfort during the procedure.   Some patients report discomfort associated with the numbing injections, but then little to no discomfort after that.  We coach you with 4-2-4 breathing, talk about kids, families, politics...  and have a few laughs and good productive conversation while you are here to make it more comfortable.   We will talk with you during the procedure to allow you to anticipate any potential discomfort.  Communication is the key!


Q:  What are the Risk/ Side effects associated with Endovenous Laser Ablation?

A:  As with any procedure, there can be risks.   Risks are uncommon, though can include:

  • Superficial Inflammation of the vessels  or Thrombophlebitis.  Thrombophlebitis can affect the heat-treated vein or branches joining with the treated vein as they come up to the "wall"  that is closed.  Thrombophlebitis is generally mild in most people: "Dr Quinn, I wouldn't even call it pain - just discomfort about 0.5 out of 10 0n the pain scale. "  It is usually an ache or tightness, with a feeling of hardness of the vein under the skin.  Our teachers who sit cross legged notice the tightness during this maneuver.  A small number of patients have a more significant version that is painful - 3-5/10, with the skin appearing pink and warm over an area of thrombophlebitis. Thrombophlebitis generally lasts about a week after the procedure, and is treated with ice, elevation, stocking use and NSAIDS such as Ibuprofen or Naproxen.  Topical NSAIDS are also used for those wishing to avoid pills.
  • Deep Vein Thrombosis (DVT) (clot in the deep vein system). DVT is extremely unlikely, less than 1 person in 100 (1%) or more likely 0.1% or 1 person in 1000.   To reduce the risk of this complication, we encourage exercise and activity, even on the day of the procedure.  You will walk before and after the procedure, and then 3-5 times a day afterwards.  We use a fair amount of cold, numbing cushion to protect the deep veins in the area during the heat sealing of the veins.  Stockings are recommended for the first week, during the day only, to gently compress the treated veins and make a deep clot less likely.
  • Incomplete closure: 0-2%. Segments of the treated vein can remain open if a large branch delivers continued flow or is pressurized before the scarring is complete.  We recommend stockings for at least 7 days after the procedure to reduce the risk of pressurizing the recently heat treated or injured vein until the area has scarred in.  If areas do remain open, often from a large branch supplying the area, injections can be done in the post procedure period.
  • Temporary (in rare cases longer-term) islands of numbness (we avoid treating parts of veins that are close to major nerves).  These islands are generally owing to superficial inflammation affecting skin branches of nerves


Q:  What are the most common side effects?


  • Bruising - Bruising can occur at the IV sites or from the numbing cushion that is placed around the vein.
  • Tightness of the treated vein. As the vein scars, it can feel tight.  Thrombophlebitis (superficial vein inflammation) can lead to tightness or discomfort.
  • Recurrence of varicose and/or spider veins can occur over time, as your original risk factors have not changed (family history of bad veins, occupation with prolonged standing or sitting, pregnancies)  We monitor you and your legs, looking for the redistribution of blood flow around the treated area as the s the blood flow re-routes.  If you have new aching, varicose veins or other troubles, we will catch the problem with our follow up ultrasound visits at 1, 3, 6 and 12 month visits to prevent progression to tissue damage.  While most people feel better after treatment, the small number who notice recurrent symptoms will have a thoughtful crew looking for the reason why and working to find solutions.


Q:  Will my varicose veins return?

A:   Your risk factors for vein disease unfortunately remain in place.  Venous insufficiency is often a progressive disease.   Despite treatment, new or existing veins may begin refluxing and lead to additional spider or varicose veins.  However, performing treatments on the existing “incompetent” veins greatly slows the progression of vein disease and helps to improve your current symptoms of vein disease and prevent the onset of additional problem veins or symptoms.  We recruit "Healthy Veins"after treatment of the troubled ones.  To check your progress and assess the new flow pattern in your legs, we will continue to monitor your veins with ultrasound and follow up visits for up to a year post-procedure.


Q:  Will my current bulging varicose veins go away?

A:  The veins will not “snap back” to normal shaped veins, though the varicose veins will be less pressurized.  We recommend you have the bulging veins removed within a week of the laser treatment of the larger vein that is supplying the varicose veins.  The removal of the bulging veins is done as a separate treatment, called an "ambulatory microphlebectomy" with local numbing medication,.  The bulging veins are removed through small needle hole sites along the length of the varicosities.  The procedure generally takes 30-90 minutes, depending on the extent of your troubles.  

Q:  What should I expect after the procedure?

A:  After the procedure, we encourage you to return to your normal activities, with a few exceptions.  For the first 24-48 hours we ask that you avoid extreme heavy lifting, high intensity workouts such as Sumo wrestling or half marathons.    We also recommend avoiding hot tubs or extremely hot baths or showers for the first few days.  We recommend that you wear compression stockings for 7 days, during the day, for the best results. We want you to be active and will have you walk on the treadmill after the procedures.  We recommend you walk or exercise 15 minutes of every hour you are awake, or take 3-5 walks/ periods of gentle exercise a day depending on your schedule.  Moving around will reduce your risk of deep vein clots and make the tightness more flexible.  You can return to work from our clinic, or care for your family as usual.  This is an ambulatory or "come and go" procedure.  For real!


Q:  Is treatment effective and what are the benefits of Endovenous Laser Ablation?

A:  Endovenous Laser Ablation procedures have more favorable results compared to that of more painful or invasive treatments such as vein stripping.  The treatment is 98-100% effective for closing the diseased vein that causes varicose or spider veins.  Other benefits of Endovenous Laser Ablation include shorter procedure and recovery times, and less pain after the procedure compared with other ablation (sealing) procedures, as well as quick relief of symptoms.  Symptoms commonly improve dramatically in the first few weeks after the procedure and continue to improve over 12 months.  You are able to return to your normal activities almost immediately.  Finally, because the procedure does not require an incision, there is minimal scarring.