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ENDOVENOUS LASER ABLATION

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Endovenous laser ablation (EVLT or EVLA) was first described in 2002 by Dr Kim, an interventional radiologist and Dr Navarro, a general surgeon. The treatment has been developed as an alternative to ligation & stripping surgery in varicose veins to treat great saphenous vein failure. In the EVLA, a thin laser fiber is first inserted into the great saphenous vein under ultrasound guidanceand local anesthesia is applied around the vessel (tumescent anesthesia). The laser device is then switched on to destroy the vessel through heat. Laser is the intensified form of visible light and is a type of energy that has been used in many fields of medicine for decades. In EVLA, both the direct effect of the laser on the vessel wall and the heat applied by the warmed blood to the inner surface will destroy the vessel and close it immediately. This vessel, with its inner surface has been destroyed, is gradually shrunk by the body's wound-healing mechanism and disappears within months.

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In what type of venous incompetence is EVLA used?

In the beginning, EVLA was used only in great saphenous vein insufficiency, but then, it has been successfully applied in small saphenous and perforating vein insufficiencies over time. Nowadays EVLA is extensively used for the closure of incompetent saphenous veins, perforating veins and their branches. In EVLA, a fluid containing local anesthetic is injected around the incompetent vessel. With this procedure called tumescent anesthesia, the patient does not feel pain, the surrounding tissues are protected from the laser and the blood in the vein is emptied making the laser more effective to its inner surface. Performing tumescent anesthesia correctly and carefully is one of the most important factors affecting the success of EVLA.

 

 

Why should EVLA be performed with ultrasound guidance?

In the treatment of varicose veins without surgery, it is very important that all procedures are performed under the guidance of ultrasound. In EVLA, all stages of the procedure from the beginning to the end should be monitored by ultrasound. In particular, in areas where saphenous veins and perforating veins meet the deep veins, it is necessary to ensure that the tip of the laser fiber is not inadvertently in the deep veins, otherwise serious complications such as deep vein damage and consequent deep vein thrombosis may occur.

 

 

What is the difference between endovenous laser and transdermal laser?

"Varicose veins treatment with laser" is a confusing expression. The laser in EVLA does not actually treat the varicose veins itself, but the insufficient veins that cause varicose veins. Therefore, for the disappearance of varices, varices should be treated separately with sclerotherapy or phlebectomy after EVLA. Furthermore, the laser application at EVLA is completely different from the laser applied to the tattoos and spider veins in beauty centers. The laser procedure at EVLA is a surgical procedure performed through a needle hole in a sterile environment, whereas the transdermal laser is based on burning very small capillary varices from the skin and is a procedure that non-physicians can also do.

 

In our country, EVLA was first performed in 2005 by Prof. Dr. Saim Yılmaz in a male patient at Akdeniz University Faculty of Medicine. The early and mid-term results of our patients were presented in various national and international congresses in 2006 and published in 2007 as an article. EVLA application, which can be done in only a few hospitals in those years, is being applied in many cities and centers today. EVLA is a revolution in the treatment of venous insufficiency and varicose veins.

 

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Click to see our scientific studies on our first EVLA application in Turkey 

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