| Endovenous laser procedure for varicose veins
Lasers have been used for numerous medical applications throughout t he body. Recently, a novel technique utilizing laser energy delivered "endovenously" (directly inside the vein) has been developed to treat varicose veins. The use of lasers has become an accepted alternative to surgical stripping to remove varicose veins. A 980 nm diode laser is used to deliver the laser energy via a small laser fibre.The procedure, termed the Endovenous Laser Procedure (EVLP, ELVeS), or Laser ablation (EVLA) is performed under local anaesthesia. A tiny laser fibre is first inserted into the diseased vein through a tiny needle (venipuncture) in the skin similar to blood sampling in a laboratory. After he Laser has been positionned energy is then delivered through the fibre, which causes the vein to close as the fibre is gradually removed.
ELVeST is optimal for treatment of:
ENDOVENOUS TREATMENT OF SAPHENOUS VEINS
The treatment of venous incompetence of the lower limbs by endovenous laser under ultrasound guidance is easy to perform in either treatment room or operating theatre setting.
Using only local anaesthesia it provides a minimally invasive, less traumatic and cosmetically optimal solution to this condition.
This endovascular technique leaves no scars and minimises the risk of infection and post-operative pain. Excellent clinical and aesthetic results have been observed with greatly reduced procedure costs 1 .
How ELVeS works...
Fibre position at SFJ
Perivenous anaesthesia and laser ernergy delivery
Treatment using fine ELVeS laser fibre
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- Following percutaneous entry into the greater saphenous vein, a fine ELVeS laser fibre is inserted into an introducer sheath and advanced towards the sapheno-femoral junction.
- Once in position (confirmed by ultrasound and the laser aiming beam), the near infrared laser energy is delivered in short pulses, causing thermal damage and contraction of the vein wall. Due to the application of tumescent local anaesthesia damage of surrounding structures is inhibited.
- The laser treatment is performed along the entire vessel length. The irreversible thermal damage induced by the laser energy then leads to a complete occlusion of the vein.
- The complete procedure takes about 30-45 minutes; the patients can return to normal activities immediately, with the exception of vigorous gym workouts.
Ref 1: Dr J-L Gerard, Phlebologist/Angiologist - Hopital Henri Mondor, Creteil, Paris, France
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ENDOVENOUS TREATMENTS OF BRANCH VARICOSITIES AND RETICULAR VEINS
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Endovenous treatment of reticular veins
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Branch varicosities and reticular veins can also be treated under direct visualisation by a similar endovascular technique.
This method is faster and more efficient than conventional treatments. The procedure is well tolerated with rapid patient recovery.
Experiences in more than 1000 patients have proved a high success rate in vessel closure. Positive patient feedback has been reported 2 additionally attributed to the fact that side effects as skin blanching or pigmental disorders are a non issue.
The endovenous treatment can also be performed on patients taking anti-coagulants or with impaired circulation.
How ELVeS works
- Following topical anaesthesia, a tiny needle is inserted into the vein. With laser fibres down to 220 µm even very small vessels can be easily treated. For larger branch varices a tumescent local anaesthesia is advised.
- Laser pulses are applied, using power of 6-10 W depending on the vein diameter. The needle is then withdrawn; this procedure is performed along the length of the varicose vein.
- For larger side branches a compression should be applied for the following days. After 8 days the varicose vein should have disappeared with no recurrences detected after one year in the treated areas. 2
Ref: 2 Intravascular Laser Therapy for Reticular and Branch Varicosities - Experience in 1000+ Patients. Dr. Berg, Blaustein, Germany
TRANSCUTANEOUS TREATMENTS OF SPIDER VEINS AND TELANGIECTASIA
Transcutaneus treatment of spider veins
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Unaesthetic Telangiectasia and Spider Veins are frequently observed in patients presenting varicose veins. These tiny veins can be treated transcutaneously with the same laser system combined with the ELVeS focusing hand-piece.
- The near infrared laser energy is well absorbed by haemoglobin and easily penetrates to underlying tissue with low absorption in the dermis.
- The surface tissue is unaffected by the laser energy as it is defocused at this level and anaesthesia is not necessary. Vessels up to 1.5 mm in diameter can be successfully treated by this technique.
WOUND HEALING FOR VENOUS ULCER
Laser light is well-known to have beneficial effects on healing wounds. The treatment of wounds with the ELVeS wound healing hand-piece encourages the wound healing process, significantly reducing the healing time.
- Low level laser energy is applied to the wound in criss-cross pattern to ensure complete exposure. This photo-stimulation effect is specifically noticeable in treatment of diabetic foot ulcers 3 .
- The laser treatment induces a positive effect in conditions of reduced microcirculation and results in the stimulation and proliferation of the patient's own cells.
ELVeST is also useful in the management of wound care and constitutes an alternative treatment that is free of side effects.
Ref: 3 The Use of the Ceralas D-15 980nm Laser in the Management of Foot & Leg Ulcers. V J Hetherington DPM, Ohio College of Podiatric Medicine, Ohio, USA.
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