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EVLA - Endovenous Laser Ablation of varicose veins

What is EVLA?

EVLA stands for Endovenous Laser Ablation. It is a method of destroying the cause of varicose veins using laser under local anaesthetic - and has many advantages over the old and out of date stripping method of surgery.

What does EVLA (Endovenous Laser Ablation) mean?

‘Endovenous’ means ‘inside the veins’ - or ‘from inside the vein’ in this case.

‘Laser’ is a sort of energy transmission by light - it actually stands for ‘Light Amplification by the Stimulated Emission of Radiation’.

‘Ablation’ is a term meaning to destroy.

Therefore EVLA means that laser is used to destroy the veins from the inside.

How is EVLA performed?

EVLA is performed under local anaesthetic as a ‘Walk-in, walk-out’ technique. There is no need for a General Anaesthetic - in fact using General Anaesthetic to perform Endovenous Laser Ablation:

  • adds the risk of an unnecessary general anaesthetic
  • adds extra cost (for the anaesthetist and general anaesthetic theatre equipment and theatre)

To perform EVLA, the surgeon needs a map of the veins to show which ones are the problem. This map is made using Duplex Ultrasound (see www.veins.co.uk).

At the EVLA procedure, the surgeon uses ultrasound to find the vein to be treated. The veins that can be treated are the main venous trunks of the legs:

  • Great Saphenous Vein (GSV)
  • Small Saphenous Vein (SSV)
  • their major tributaries such as the Anterior Accessory Saphenous Veins (AASV)

EVLA does NOT treat the bulging veins on the surface (the varicosities). These are treated after the EVLA by other methods.

Under ultrasound control, a needle is put into the vein near the knee or ankle. A wire is passed into the vein and a long ‘sheath’ is passed up the vein to the top. This ‘sheath’ is a thin tube about the width of a biro refill (for pictures see the EVLA page on www.veins.co.uk).

The ultrasound is used to position the end of the sheath exactly.

Local anaesthetic is injected around the vein - again using ultrasound to make absolutely sure the fluid is in the right place. The local anaesthetic fluid has 3 uses:

  • Local anaesthetic numbs the vein and the surrounding tissue
  • Adrenaline in the mixture causes the vein to contract onto the laser sheath giving good contact
  • The volume of fluid disperses the laser energy - making sure the tissues around the vein are not harmed when the vein is destroyed by heat

This technique is called ‘Tumesence’ or ‘Tumescent anaesthesia’.

Once the anaesthetic is in place, the laser fibre is passed up inside the sheath until it comes out of the top. The fibre is fixed to the sheath and the laser is switched on.

The sheath and laser are then pulled back at an exact rate, making sure the vein is completely destroyed - but without damaging the surrounding tissues.

There are variations to the technique above, but research from The Whiteley Clinic and elsewhere has shown this technique to be safe and reproducible (for research please see www.pioneering-veins-surgery.co.uk).

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