Endovenous laser ablation
What are thermal endovenous procedures?
- These newest techniques are also called thermal ablation therapy for varicose veins, or thermal endovenous procedures.
- Their aim is to destroy the saphenous veins and some of their branches with heat. The veins are then ‘cauterized’.
- Heat is delivered either by a laser beam or by ultrasound (in the case of radiofrequency). There is also another device that delivers heat from steam.
- Endovenous treatments are designed for saphenous veins, whether great saphenous or small saphenous, and some of their branches, but the varicose veins have to be at least 4 mm in diameter.
- There is no difference between LASER and radiofrequency procedure. The two procedures share the same steps, the only difference is the type of fiber used to deliver the heat. What matters the most is the ability to deliver enough heat within the varicose vein to destroy it.
- For you, whatever the technique, the results are identical: your varicose veins will be destroyed by the heat. The benefits are instantaneous. You will be relieved of the symptoms you experienced within a few days.
- Once destroyed by laser or radiofrequency, the varicose vein will then progressively resorb within a few months.
- At this moment, only radiofrequency ablation is reimbursed by the French social security.
How are LASER and radiofrequency procedures performed?
- Both are ambulatory procedures. They take place in an operating room.
- You don’t need to stop your anticoagulant (PREVISCAN®, SINTROM®, COUMADINE®, XARELTO®, PRADAXA®, ELIQUIS®) or your antiplatelet medication (ASPIRINE®, PLAVIX®, EFIENT®, BRILIQUE®).
- Local anesthesia is performed. Then, the fiber is introduced into the vein using constant ultrasound guidance. The tip of the fiber is positioned in the groin for the great saphenous vein, and in the back of the knee for the small saphenous vein.
- Once the fiber is properly placed, a second round of local anesthesia is performed, called tumescent anesthesia: its purpose is to surround the vein by saline mixed with an anesthetic(XYLOCAÏNE®).
- Tumescent anesthesia has two functions: first, it will squeeze the vein and the laser or radiofrequency fiber together to get maximum contact, and then, it will protect the skin and the muscles from the heat delivered by the fiber. Saline works as a heat pump.
- Once tumescent anesthesia is done, the LASER or radiofrequency beam is then ‘fired up’ and is pulled down the vein: this lasts only a few minutes.
- You should only experience a slight pulling or a sensation of warmth when the laser or radiofrequency beam is ‘fired up’. We will make a pause in the procedure if anything more painful shows up: because there is no general anesthesia, patients are able to give us feedback about what they feel when the laser or radiofrequency beam is fired up, reducing the risks of complications, mainly nerve or muscle damage.
- Once the procedure is over, the fiber is withdrawn, and a strip STERISTRIP®is placed on the puncture site. There is no need for stitches since the incision is very small.
- The incision is covered and closed by a small dressing called STERISTRIP®. There are no stitches, thus no need to remove stitches.
- Then, compression stockings will be applied.
- The procedure takes 20 to 30 minutes per leg.
What happens next?
- LMost of the time, no sick leave is necessary after a LASER or radiofrequency ablation. You can go back home on your own.
- We will determine how long compression stockings must be worn afterwards, generally between 1 and 4 days.
- STERISTRIP® will fall off on their own when the incision is healed.
- You can travel if you need to, even by plane.
- A follow-up consultation will be scheduled 1 week after the procedure. We will remove the remaining STERISTRIP®, if needed.
What could be the risks?
Side-effects that can occur immediately and a few days after the procedure:
- Some bruising might appear where local anesthesia was performed, on the thigh or on the leg. Bruising is generally painless and will disappear within a few days.
- Mild discomfort, tenderness and pulling sensations might be experienced for a few days on the line of the treated vein. Generally, painkillers or anti-inflammatory medications are effective to relieve these symptoms. Class 2 compression stockings worn during the day will also be of great help.
- Phlebitis or thrombophlebitis might occur: the risk is very low because walking is allowed right away after the procedure and will activate the circulation. Nonetheless, in certain cases, anticoagulant injections might be prescribed to prevent the risk of thrombosis.
- Brown staining of the skin of the thighs or the legs along the treated veins might occur, especially when the vein is very superficial. This brown staining will fade away within a few months.
- Nerve damaged by the laser or radiofrequency fiber are responsible for sensory nerve disorder. This complication is very rare and is easily prevented by the fact that there is no general anesthesia and the patient can signal any pain feeling like an ‘electric discharge’ when the laser or radiofrequency beam fires up. If so, the position of the fiber is immediately corrected so that there is no more risk of damaging the nerve.