EVLA: Endovenous Laser Treatment for Varicose Veins

Endovenous laser ablation, or EVLA, closes a faulty vein from the inside using laser energy delivered through a fine catheter. NICE recommends it as a first-line treatment for varicose veins, and at Anglia Vein Clinic it is carried out as a day case, usually under local anaesthetic, by consultant vascular surgeon Mr John Prionidis PhD FRCS.

 

Why the vein matters more than the bulge

The bulging veins you can see are rarely the problem in themselves. They are the result of a leak higher up — usually a failed valve at the groin or behind the knee — that lets blood fall back down the leg and stretch the veins beneath the skin. EVLA treats that source directly. Once the faulty trunk vein is closed, blood is redirected into the healthy deep veins, which already carry the great majority of the return from the leg and take over immediately.

 

Is EVLA right for you?

EVLA suits most people whose varicose veins come from a leaking great or small saphenous vein. Whether it is right for your leg depends above all on your duplex ultrasound scan: which veins are leaking, how large they are, how deep they run and how close they lie to a nerve or to the skin. That is why nothing is decided before the scan.

It may relieve aching, heaviness, swelling, or night cramps; treat visible bulges; or protect the skin where it has begun to change colour or texture around the ankle. If a vein is very twisted, very close to the skin or unsuitable for a catheter, another technique such as foam sclerotherapy or phlebectomy may be better.

 

What happens during EVLA

1. Your veins are marked on the leg with ultrasound while you stand.

2. After local (or, if you prefer, general) anaesthetic, a fine catheter is passed into the vein through a single needle puncture, guided by ultrasound.

3. A dilute local anaesthetic solution, called tumescent anaesthesia, is placed around the vein. It numbs the area and protects the surrounding tissue.

4. Laser energy is delivered as the catheter is slowly withdrawn, sealing the vein shut.

5. A bandage and compression stocking are applied, and you are walking within minutes.

The procedure usually takes 45 to 90 minutes per leg. Visible bulging branches are often removed at the same session through tiny punctures (phlebectomy), or injected with foam.

 

What it feels like

Under local anaesthetic, the only sharp sensation is the first injection. After that, you may be aware of pressure, movement or a cool feeling as the anaesthetic solution goes in, but not pain. You can talk to us throughout. If you would rather be asleep, EVLA can be done under general anaesthetic instead; we agree this before the day.

 

Recovery after EVLA

You go home the same day with a compression stocking, which stays on day and night for 48 hours. Walking for five to ten minutes every hour is the most useful thing you can do. Most people return to desk work after 48 hours, and to the gym, running and heavy lifting after two weeks. Don't drive for 48 hours, and don't drive until you can stop in an emergency without hesitating. See our recovery and aftercare guide for the full timetable.

A pulling or tight feeling along the inner thigh between days five and ten is common as the treated vein contracts and settles over two to three weeks.

 

Risks

EVLA is safe and effective, and most people experience nothing worse than bruising and a few tender lumps. Temporary tingling or numbness from irritation of a nearby nerve occurs after about 1 in 30 thermal ablation procedures and usually improves over weeks. Deep vein thrombosis occurs in between 1 in 100 and 1 in 300 cases after thermal ablation and is usually a small, symptom-free clot found on the routine follow-up scan. Pulmonary embolism is exceptionally rare, at under 1 in 1,000. We go through every risk that applies to your leg at your consultation.

 

EVLA or radiofrequency ablation?

EVLA and radiofrequency ablation both close the vein with heat through a catheter, and outcomes are very similar. The choice depends on the anatomy of your vein and is explained at your consultation.

 

Why have EVLA at Anglia Vein Clinic?

Mr Prionidis performs every consultation, scan review, procedure, and follow-up himself, so the surgeon who assesses you is the one who treats you. He has 24 years' experience in vascular surgery. Treatment is available at Springfield Hospital and Phoenix Hospital in Chelmsford, St Edmunds Hospital in Bury St Edmunds, and Weymouth Street Hospital in central London.

No GP referral is needed, and we welcome both self-pay and insured patients.

To book a consultation, call 01245 241 340 or email info@avclinic.co.uk.