EVLT FAQ Page In St. Louis

You want someone who is, in fact, a vein specialist. Vein specialists have specific background, education, and training in venous disease. They are board certified in venous disease, or Phlebology. You also want someone who is devoted to treating venous disease only, and is doing this every day as the focus of their practice, not practicing a different specialty 4 days a week, and treating veins on, say, Friday afternoons. Finally, make sure their office offers the full spectrum of treatments for both varicose and spider veins, so that you can be sure you are getting the most appropriate treatment for your specific case. If they only offer one or two treatments, then everybody gets treated the same way. Also make sure that everything you will need for evaluation, diagnosis, and management can be done in one location, so you won’t be sent all over the place.

After having the endovenous laser ablation on both legs, I have developed large ulcers on one of my legs. What could have caused this? This has been a very long and painful experience.

EVLT is very unlikely to cause leg ulcers, unless the vein treated was very superficial and a skin burn was caused which is theoretically possible, although I have never seen this.

I had EVLT done back in May and just recently my leg has a lot of aching and pain where it was done. Its sore to touch and its tender. There is also numbness in that spot of leg, very achy, where the surgery was performed. What could be the issue? 

Numbness can be from cutaneous or skin nerve damage that will improve over time. Soreness this far out is likely associated with a hard, but closed vein, or an open vein near the closed area. It is difficult to answer this question adequately without seeing how much of the saphenous was ablated or what additional treatment was done. There may still be more work to do on that leg. So it is important to follow up with the physician who performed the procedure and to be checked with an ultrasound.

As with any procedure, there can be complications, so it is important to have the procedure performed by a qualified physician. The most serious complication is a clot in the deep system of veins. Another potential issue is the inadequate closure of the treated vein, leading to recurrent varicose veins. Overall the procedure is safe and successful in the majority of patients.

For the most part endovenous laser treatment (EVLT) is done on the large veins, i.e. greater saphenous and lesser saphenous. Occasionally some large tributary branches can be treated with EVLT as well. For the most part, a single EVLT treatment on each vein suffices. The success rate is over 98% so very rarely does the treatment need to be repeated in the same vein. Most patients need more than EVLT for the proper treatment of their varicose veins. Treatments like phlebectomies and ultrasound-guided sclerotherapy are quite often used.

Venous circulatory symptoms usually manifest with leg heaviness, pain that increases during the day, and skin changes at the inner ankle, such as redness and/or brown discoloration. The symptoms of coldness of the feet are not typical of venous disorders. Inadequate arterial circulation can be associated with coldness, but also usually has a very characteristic pattern of increasing coldness and pain when walking a distance which is fixed and reproducible. A professional exam to palpate foot and ankle pulses should be able to evaluate arterial insufficiency.

Coldness of the feet and hands with normal artery pulses is usually indicative of a condition known as Raynauds Disease, which is a neurologic triggering causing constriction of the small arteries in these areas which is the body’s normal defense response to environmental cold. In individuals with Raynauds Disease, the “trigger level” is set at a more sensitive level than average. This is almost always a benign condition treated with socks. Another possible cause of coldness in the feet can be nerve damage, but often there will be other associated changes in sensation. Thus, in summary, an Endovenous Laser procedure for varicose veins may be of benefit for your vein problems, but it may not help your coldness in your feet.

Can ELA or other vein treatments improve overall circulation, perhaps improving PCS symptoms? I have bad varicose veins in the legs as well as hemorrhoids and was hoping that treating them would improve my PCS symptoms as well. 

Treating superficial venous reflux may help lower leg symptoms but does not address PCS. The valve problem in the pelvic veins must be addressed either through direct ligation of pelvic or sapheno-femoral branches or sclerotherapy of the branches.

The treatment carries little risks. A very small number of people develop blood clots following treatment with ELVeS {less than 2 per thousand treatments}. The only other reported side effect is some numbness in the affected area, which usually disappears with time.

Recovery is generally quick and almost pain-free. The doctor will apply a compression garment and ask the patient to walk around the office for about 20 minutes before leaving. Patients may return to normal activities other than strenuous exercise, but compression stockings must be worn for about a week. A pulling feeling may be felt but can be resolved with over-the-counter pain medication.

This system is effective for problems with both the greater and small saphenous veins. Most individuals with incompetent or leaky superficial veins of the legs are perfect candidates.

ELVeS takes less than an hour and can be done without general anesthesia or hospitalization. Other procedures can leave scarring and are much more expensive and often requiring hospitalization. According to most patients the worst pain involved is the injection of lidocaine, which feels something like a bee sting.

Endo Laser Vein System (ELVeS). This procedure, developed by Biolitec, stops the blood from flowing backwards and pooling as a result of problems with the greater saphenous vein. ELVes uses laser light energy to constrict the walls of the damaged vein and direct the blood supply to healthier areas.

It depends on the procedure. An endovenous laser ablation takes less than 20-30 minutes. Microphlebectomy (removal of the superficial veins) can take an additional 30-40 minutes depending on how many veins. The old way of treating veins (stripping and ligation) is no longer necessary which took even longer. There is no downtime for the current procedures. Some bruising is to be expected.

I have 6 weeks left of pregnancy, and I have varicose veins, they are causing me a lot of pain, and I have a spot that always feels hot. Can I have laser therapy now during pregnancy?

Unfortunately no. This procedure would not be safe to do while you are pregnant. You should wear compression stockings every single day. The best option is to put them on before you get out of bed in the morning and not to take them off until you go to sleep at night. Elevating your legs for periods of 10-15 min at a time, 3-4 times a day can also help. After the baby is born, then you can plan to have your veins treated. Best wishes for a healthy baby.

For how long are stockings required after endovenous laser ablation? How do they help?

I have my patients wear their stockings for only 1 week after ablation. But they can be doing almost all normal activities during that whole time. Some patients prefer to wear them a few more weeks for comfort reasons. The stockings maintain compression on the treated vein to prevent it from opening back up, as well as reducing swelling, bruising, and providing support and protection to the limbs as healing progresses.

I have very obvious varicose veins on one leg, and already know I want to have them treated with ELA. 

Venous reflux exams are very important prior to any vein procedure. Not only will they define the severity of the problem, but most importantly give precise information about the anatomy, and that is crucial at the time of the EVLT procedure. Besides, many insurance companies will not authorize the procedure unless there is a venous exam confirming the presence of reflux.

Is local, topical, or general anesthesia typically used during this procedure? 

Just local anesthetic, Lidocaine, is used for pain control. This is the safest and most effective way to prevent discomfort. General Anesthesia is just not necessary and it adds additional risks. Topical anesthesia rarely can provide adequate anesthesia.

The odds of a treated vein returning are about 2 in 100. Although some studies have reported a little more or less recurrence, 2% is probably the best estimate.

As long as there are no contraindications such a history of stomach ulcers or kidney disease, I generally recommend Ibuprofen for post procedure pain and inflammation. Many people have no or little discomfort and they don’t need to take any medication. Some people have some discomfort and Non-steroidal inflammatory medications such as Ibuprofen seems to work the best.

They’re treating the veins on my legs, nowhere near my face. I have severe claustrophobia and am hoping they can treat me without my needing to wear anything on my face. 

The purpose of the protective eyewear when a laser is used is to protect the retina from the laser. The medical recommendation is to wear them, and depending on state laws, you may legally be required to wear this eye protection. You are however correct in identifying the minute probability of this exposure during leg laser treatment. Furthermore, the laser is only activated once it is under the skin so that direct eye exposure is eliminated. In the vast majority of instances, the treating professionals do not wear eye protection for these very reasons. Your phlebologist may waive your need to wear the glasses and it is helpful to know that the laser is only used for an average of 2 minutes.

It is not typical for simple bruising to persist for 10 months. However, what you are experiencing may not be just bruising. It is possible that the discoloration you are seeing is actually what we refer to as staining, and represents blood that was trapped in the treated vein, and appears as a light discoloration, often appearing like a light bruise, on the skin surface. This can last for an extended period of time, but does generally diminish and disappear over time. The most important thing is that if you have continuing questions or concerns, you should be seen again by your treating physician, who can evaluate your situation, and determine if there is anything further that needs to be done, or can offer potential treatment options for you.

Many physicians require that you are driven home after the procedure. This is precautionary. If you are sedated for the procedure, you certainly should have a driver. Without any sedation, you may be able to drive at the discretion of your doctor. Most of my patients don’t receive any sedation and they can drive home after the procedure. Recovery is typically very easy, with most patients returning to normal activities the day of the procedure.

It is thought to reduce the risk of blood clots. Blood clots can occur after any surgical procedure including an EVLT. The risk of a blood clot is very small after an EVLT procedure. The estimated occurrence is less than 2 per thousand procedures. Walking shortly after a surgical procedure can reduce the risk of blood clots. It is hoped that by walking shortly after the EVLT procedure the risk can be further reduced perhaps to zero but that is not proven.

They are similar. The EVLT was the first trade name for the Endovenous Laser Ablation / Treatment. ELVeS and EVLT are both laser procedures but use different wavelengths to get the job done, and both do a good job. I use both the 1470 ELVeS in my practice. The ELVeS has the advantage of being a gentler laser with much less bruising and less post op pain. The EVLT is better for very large veins over 2cms.

I have nerve damage from endovenous ablation. Around my ankle is highly sensitive and it hurts to touch. I had this treatment in June 2010 and still having a lot of problems. Is this treatable?

Often this complication improves over time. I would first discuss this with the vein specialist who did the treatment. Another option would be to obtain a consultation with a neurologist. He/she will be able to evaluate how much of damage you have in the nerve and give you further advice.

Can a laser effectively occlude an incompetent Saphenous femoral junction? If it does, which modality is better; Diode or NdYag?

Technically, you do not want someone to occlude your saphenofemoral junction. The occlusion should extend to a short distance below the saphenofemoral junction. All of the lasers in routine use for saphenous vein ablation work very well. There is some research that some may be slightly better tolerated but they all work well.

Yes, Endovenous Laser can be used to treat refluxing perforator veins. Insurance companies often times will not cover this treatment as they consider it experimental. However, in some cases doing an appeal with your insurance company can result in coverage.

The ELVeS is a similar procedure to the EVLT. The laser and type of fiber are different. The laser emits light at a wavelength that is more absorbed by water and is associated with less bruising.

I have previously had sclerotherapy for my veins with excellent results. Now, a doctor, said my valve is problematic so the Laser should be used. I guess I’m a little nervous about the procedure. 

In good hands ELVeS (Endo Laser Vein System) is a very safe procedure with very low chances of complications. Two rare but possible complications that are reported in the medical literature are: Deep Vein Thrombosis, and a clot forming in the femoral vein if the laser fiber was not properly positioned. Another rare but possible complication that can occur is a skin ulcer if the vein is too superficial and/or high energy is delivered. This is an ever rarer complication but it has been reported to have occurred in at least one of the thousands of ELVeS procedures performed.

I had EVLT done about three months ago..right after the EVLT procedure I started feeling weird sensations in my ankle and now the pain seems to get worse every day? Could this pain be associated with the procedure?

EVLT can be the cause of nerve damage, especially of the small sensation nerves. If this occurs, healing can be expected, however patience is required as nerve tissue is the slowest type of human tissue to heal. It can take up to a year for nerve damage to heal. The sensory nerve is particularly close to the greater as well as the short saphenous veins at the ankle level. Thus, if the vein is treated this far down the leg, the incidence increases. The fact that your discomfort is worsening may actually not be a negative factor. As sensory nerves regenerate, they can create uncomfortable sensations but may represent healing.

I’ve heard that ELA hurts more than RO. Is this true? They sound like sort of the same thing; why would one hurt more than the other? 

As to pain during the procedure, there should be absolutely no difference. No pain should be felt during the ablation if the local anesthesia is administered correctly. Generally there is minimal to mild pain after these procedures, treated with at most ibuprofen being taken as needed. There are no head to head studies that have compared what laser and radiofrequency ablation patients experience. However, the mild discomfort experienced for a week or two after the treatment is certainly very similar.

Can endovenous laser ablation be used to treat multiple veins, or only the greater saphenous vein? Will it take care of varicose veins that are closer to my ankles? 

Endovenous Laser Ablation (ELA) will treat veins other than the saphenous. However, most veins lower in the leg must be treated with sclerotherapy or vein stripping. The ELA treats the larger sources of the problem, but is often impractical when dealing with twisty, small veins, especially on the very low leg or ankle.

Mapping of a vein is done prior to any EVLT procedure. Ultrasound is done prior to even minor procedures such as sclerotherapy, this eliminates the possibility of missing an important refluxing vein. The EVLT procedure is done entirely under ultrasound guidance.

The idea of having endovenous laser ablation on my legs sounds a little scary. Is there a risk of getting burned during the procedure? 

There is a small risk of getting a burn, however using tumescent anesthesia this risk is reduced greatly. Tumescent anesthesia is essentially a mixture of salt water and numbing medicine that surrounds the entire length of the vein. The mixture will absorb the stray heat of the laser and protect the surrounding soft tissues.

No, Endovenous Laser Ablation does not remove veins. The cells of the veins or tissue are replaced with healing tissue. Think about a scratch on your skin. A scab develops then as the healing process continues the scab cells are replaced with healthy new tissue over the following weeks. After a couple of months, it is hard to even tell where the scratch was. Usually, after a year, there is no detecting where the scratch was. The same healing process goes on with your veins. So after a year it is usually impossible to tell where the treated veins were.

Most YouTube videos I have watched show only thigh veins being tackled by EVLT. No videos show leg veins or tortuous veins. Does this mean it is difficult to use lasers in these situations? 

The ELVeS and EVLT are used primarily to treat the saphenous veins from the mid-calf up to the thigh. Refluxing saphenous veins often rise to the more superficial tortuous veins on the thigh and further down the leg. Although the laser fiber has some flexibility, it cannot travel to tortuous tributary veins. The same problem occurs with radiofrequency ablation (RFA). There are other approaches that can be used for those veins. These methods can be as effective to treat them and have excellent results as well.

I realize that the endovenous laser treatment cannot be used for the lower leg and I was wondering if ELVeS could be an alternative for me. Thank you.

Yes, ELVeS (Endo Laser Vein System) can be used to treat varicose veins on the lower and upper leg. Greater caution is required with both of these procedures below the knee because of the proximity of the saphenous nerve with the saphenous vein, the usual target of the treatment. There is some hope that, because the ELVeS uses less energy, it may have a lower risk of complications, but this is not proven.

I have a varicocele and am looking for treatment, is endovenous treatment a good option? 

Absolutely NOT. ELVeS should not be used to treat a varicocele. ELVes is only for the treatment of a particular type of varicose vein of the legs. It is FDA-approved for varicosity of Greater Saphenous vein, and is usually applied to the thigh level of the vein. Varicoceles are best treated surgically if they need to be treated.

I’ve heard that ELVeS can prevent new varicose veins from occurring, and from recurring once a given area has been treated. Is this true, and if not, can any treatment prevent varicose veins?

ELVeS (Endo Laser Vein System) is a new endovenous laser treatment that treats the underlying cause of most varicose veins: saphenous and small saphenous vein insufficiency. Treating the underlying cause in turn will likely prevent the development of new varicose veins in the area of the leg that is served by the treated vein.

I am significantly overweight and have very painful varicose veins in my legs. Is it better for me to have surgery or endovenous laser treatments? 

EVLT or ELVeS/radiofrequency ablation are preferable in most individuals and even more so for overweight individuals. There are several reasons for this preference. First, general anesthesia is not used for EVLT or ELVeS ablation and overweight patients are at higher risk for complication for general anesthesia. Another reason is that ligation and stripping procedures require incisions. In overweight individuals, there is an added risk of poor healing and infection with incisions from stripping procedures. This would be especially applicable to a groin incision that is usually required to treat the greater saphenous vein.

I just had Endovenous Laser Ablation and some of my bandages are blood soaked. Is this normal or is something wrong? 

Some blood in the bandages is seen sometimes. It is not a serious or concerning complication for the great majority of patients. Compression for 5-10 min should take care of the problem. If it continues bleeding, you should notify your doctor immediately.

I’ve heard that ELA can result in deep vein thrombosis. Is this true, and how common is this complication? Is there any way to prevent it?

Yes, Endovenous Laser Ablation can cause a deep vein thrombosis. Studies show that this is an uncommon occurrence happening in less than .5% of cases; or less than 5 in 1000 treatments.

Is Endovenous Laser Ablation or VNUS Closure Fast a more effective way to treat a dilated greater saphenous vein with gross incompetence from the saphenofemoral vein down the lower leg, contributing to superficial venous hypertension? 

Endovenous Laser Ablation and VNUS Closure Fast have similar effectiveness. Actually, Endovenous Laser Ablation has a slightly better effectiveness. There is generally more discomfort with greatly dilated saphenous veins.

I have both spider veins and varicose veins. Will endovenous laser ablation treat both of these problems? 

Endovenous laser ablation treats a leading and prominent cause of varicose and spider veins. Usually [>80% of the time] some sclerotherapy (injection treatments) is needed to “clean up” the remaining varicose and spider veins that are not reduced by the endovenous laser treatment. Occasionally, less than 20% of the time, the treatment of the underlying reflux with the EVLT leads to enough improvement or resolution of both spider veins and/or varicose veins that no additional treatment is required.

Normal activity should be okay, including walking, standing, and house chores. Activity can essentially be resumed right away. Rigorous exercise and heavy lifting (>20lbs) will need to be delayed by 1 week. Typically, showering is okay immediately as well. I advise compression stocking use on the leg for 1 week after the procedure.

Lipodermatosclerosis is a form of scarring due to venous insufficiency. It will not go away with the laser procedure but may improve if treatment gets rid of the cause of your venous insufficiency.

I had EVLT 3 weeks ago. When I went for the 2-week follow-up, it showed that the vein was still open. My doctor said he needed to redo the procedure. I thought this was a one-time procedure, and am confused as to what my options are. 

An EVLT is usually, 98% to 99% of the time, a one-time treatment. That is 98-99% that after treatment, the vein is closed and it stays closed for at least several years. Since our data only goes back years, that is all we can demonstrate, though it’s possible we may learn the vein stays closed forever. Redo procedures do occur, but they should be uncommon after a treatment.

I had EVLA done on 3 veins recently. I know 1 was the small saph., the other two names I am not sure. Also had sclerotherapy on both legs. When can I go back to karate and kickboxing. We do kick pads pretty hard. Training for my black belt! 

We have patients refrain from vigorous physical exercise for a week after EVLA. But contact the physician who performed the procedure to be sure.

I had a laser treatment done on a deep vein when I was 4 weeks pregnant and did not know I was. Now 23 weeks along, I am nervous that the general anesthesia at such an early time in gestation will cause long term effects. 

I do not know how your procedure was done, but we never do laser ablation under general anesthesia. In our office it is done under local anesthesia, with perhaps a small dose of an oral sedative, and is very safe, even if one is pregnant. There definitely would be some risk to you and your fetus if you did, in fact, have general anesthesia, although for the life of me, I do not know why any physician would perform this procedure using such extreme anesthesia.

EVLT is a minimally invasive procedure performed in the office entirely under local anesthesia, or with a mild oral sedative. There is minimal discomfort experienced during, or after, the procedure. The vein that is treated lies at various depths under the skin, so the skin must first be numbed so that the subsequent treatment can be done without any discomfort at all. What you will feel will be just a few tiny, little needlesticks to first numb the skin.

Once this is done there is truly little, to any, discomfort at all. Since the cannula through which the laser is placed goes in through a needlestick, there are no incisions needed, and no scarring at all. The needlestick hole will fade over the first few weeks to nothing more than the appearance of a tiny freckle, and over a period of weeks to months will fade completely, leaving no residual mark or scar.

No the ELVeS (Endo Laser Vein System) is only used for refluxing saphenous veins.

There is some evidence that the size of the vein affects long term closure. The best way to scientifically make this adjustment is to not just keep track of the amount of energy given per centimeter LEED, but also the amount of energy delivered per centimeter of length and per surface area of vein wall {which is determined by its diameter}.This calculation is called the endovenous fluence and should be used to give the optimal energy to have successful treatment of the vein. At this year's annual congress of the American College of Phlebology, I presented a paper that looked at what average endovenous energy densities were not successful and which were successful at 2 year closure of saphenous veins. It is clear that the amount of energy delivered to a vein should be increased for larger veins

Endovenous Laser Ablation, ELA, has a very small but real risk of complications such as DVT and or phlebitis. The risk is somewhere between 1 in 1000 and 1 in 10,0000 ELA will have that complication. Factor V Leiden is an inherited disorder that increases the risk of phlebitis or DVT by 8 fold for patients heterozygous (have one copy of the gene) for the disorder and 80 fold for patients homozygous (have two copies of the gene). So yes there is higher risk.

I’d like to treat my varicose veins. Do I need referral from my general practitioner to have Endovenous Laser Ablation? 

This depends on your insurance. If you are in an HMO, you most probably need a referral. If you have a PPO plan, more than likely you do not. Your plan type makes the difference.

I had it done in March. My leg feels better, even though I know I’m still healing. But the past couple of days I haven’t been feeling well. My chest is achy. 

There is less than 1% chance of developing DVT after EVLT, and probably less in experienced hands. However, with your onset of symptoms, the prudent course would be to have a venous ultrasound to rule out DVT and subsequent traveling of the clot to your lungs (pulmonary embolism) which occurs occasionally after a DVT.

I had an EVLT procedure done on the left leg 2 weeks ago, and then the right 1 week ago. I usually go to the gym twice a week but I haven’t gone since my visits. When can I begin exercise again? 

I usually tell patients to wait a week, but listen to your body. Take it easy if there is discomfort.