Why use EVLA and the difference between EVLA and EVLT^®

Varicose veins are often thought to be the lumpy veins that people see on their legs. Although these veins can be seen in some people with vein problems, these visible varicose veins are not the real problem. They are just a sign of the underlying major problem - venous reflux or ‘vein pump failure’. This is explained in detail with diagrams on www.veins.co.uk under ‘how veins work’).

So to treat varicose veins and the other vein problems successfully (such as phlebitis, venous eczema, lipodermatosclerosis, venous leg ulceration and even many people with thread veins of the legs), the underlying main veins that aren't working, which means they let the blood fall the wrong way down the leg causing the damage, need to be fixed by reversing the blood flow.

Unfortunately, when the valves stop working in these main veins, the the valves cannot be fixed. Therefore, to stop the blood from flowing the wrong way down the veins and causing damage, we need to close the veins completely and permanently.

Over the last 100 years, surgeons have operated on patients with varicose veins and venous diseases by tying the veins closed and then stripping them out (see www.veinsstripping.co.uk). However, prize winning research by us, at The Whiteley Clinic, has shown that this barbaric operation doesn't even work in a large number of patients - as the veins grow back!!!

However, we have also shown that if the same veins are destroyed by heat – for example by using EVLA - the veins are closed in a way that makes them shrivel away and never grow back again.

Are there different sorts of EVLA - and what is the difference between EVLA and EVLT^®?

Simply answered - yes there are!!! When something works, lots of companies produce similar products to "get in on the act".

Originally the technique was invented following a discussion by 3 doctors at a venous meeting in 1998:

• Dr Carlos Boné from Spain
• Dr Luis Navarro from the USA
• Dr Robert Min from the USA

(Endovenous laser: a new minimally invasive method of treatment for varicose veins--preliminary observations using an 810 nm diode laser. Navarro L, Min RJ, Boné C
Dermatol Surg. 2001 Feb;27(2):117-22 - click here to see abstract)

There had already been some success shown by using heat to destroy the venous trunks using radiofrequency (VNUS Closure^®) and so these doctors started using laser to do the same.

Initially they used a laser called a diode laser, that produced laser "light" at a wavelength of 810 nm. This was highly efficient in destroying the vein wall, but caused quite a lot of bruising in some people. The 810 nm diode laser was patented and called it EVLT^® - EndoVenous Laser Treatment or EndoVenous Laser Therapy. This technique was originally picked up and sold by a company called Diomed.

Other companies saw the potential and started producing equipment and lasers to destroy varicose veins the same way. As EVLT^® is a registered trademark, they had to think of other names to call their products. Many of them had different sorts of sheaths or equipment - others used different laser wavelengths.

There are now many different forms of EndoVenous Laser - ie: 810 nm, 940 nm, 941 nm, 1064 nm, 1320 nm and other wavelengths - different sized sheaths, end-firing lasers fibres and side-firing laser fibres etc. However ALL of them are forms of EVLA - as they all ablate veins from within using laser.