Understanding Endovenous Laser Therapy (EVLT): Is It Right for Your Vein Problem?

If you have dilated, swollen leg veins, you’re not alone: Nearly one in four adults in the United States has large, “cord-like” varicose veins (varicosities), and about four in five Americans have smaller sprawling “webs” of spider veins (telangiectasias).   

No matter what type of vein distortion marks your lower extremities, our team at Advanced Vascular Surgery has a minimally invasive solution that can clear it from your skin.    

In certain cases, endovenous laser therapy (EVLT) is the most effective vein clearance treatment. Here’s when it may be the best choice for your vascular problem. 

Minimally invasive vein ablation methods

The term endovenous ablation covers the various minimally invasive vein care techniques that work to clear away damaged, dilated veins safely, quickly, and without surgery. 

Each ablative vein method takes a slightly different approach to accomplish the same goal: To irritate or otherwise affect the inner lining of the targeted vessel, prompting it to collapse and gradually fade away. Our team can force vein closure and clearance with:

• A liquid or foam sclerosing agent
• Controlled thermal energy (heat)
• A mechanochemical mechanism 

Sclerotherapy, or chemical ablation, involves injecting a liquid or microfoam medication into a damaged vein to force its collapse; thermal endovenous treatments use either radiofrequency (RF) energy waves or targeted laser heat to deliver vein clearance results. 

Understanding endovenous laser therapy

Endovenous laser therapy (EVLT) uses precision-focused laser energy (heat) to make the targeted vein contract, collapse inward, and seal itself shut. 

After mapping your vein and planning your treatment with vascular ultrasound imaging, we numb the vein pathway with injections of a local anesthetic. Using continuous ultrasound guidance, EVLT closes off the faulty veins in four basic steps:

1. Incision: We make a small incision over one end of the targeted vein
2. Insertion: We thread a thin catheter and laser fiber down the length of the vein
3. Activation: Once it’s in place, we activate the thermal tip of the laser fiber
4. Ablation: We slowly withdraw the laser, heating the vein along the way

As it’s extracted, the laser fiber’s heat impels the vascular walls to contract inward and close. Within weeks, the collapsed vein forms into harmless scar tissue and gradually fades away.

Vein problems we can address with EVLT

Laser ablation is a highly effective way to treat varicose veins, with a 95%-100% success rate of full vein closure and a very low rate of recurrence. It also delivers effective symptom relief for chronic venous insufficiency (CVI), or venous reflux. 

CVI occurs when damaged vein valves allow blood to pool and exert pressure on vascular walls. Besides contributing to varicose vein development and/or progression, CVI causes sluggish lower extremity circulation that can give rise to complications like persistent leg swelling (edema) and skin changes. 

Is EVLT right for your vein problem?

EVLT is the go-to endovenous ablative technique for many typical cases of vein damage and CVI. Our team typically recommends this treatment approach for patients with:

Moderate to severe varicose veins

EVLT is primarily used to target and eliminate moderate to severe varicose veins that are visibly swollen, bulging, or twisted, as well as those accompanied by bothersome CVI symptoms like leg pain, aching, swelling, heaviness, or nighttime cramping. 

Confirmed saphenous vein reflux

Patients whose venous ultrasounds confirm CVI, also known as venous reflux, in a major “trunk” subsurface vein — either the great saphenous vein (GSV) or the small saphenous vein (SSV) — can benefit from an EVLT vein clearance treatment. 

Inadequate relief from conservative care

You can also benefit from EVLT if your varicose veins and/or CVI symptoms haven’t improved after 3-6 months of conservative care strategies like compression therapy and lifestyle changes (e.g., exercise, weight loss, less time sitting).

When EVLT isn’t the best treatment option

Because EVLT involves catheter insertion, it’s strictly used to close larger, faulty “trunk” varicose leg veins that are relatively straight. We can’t use this method to treat:

• Smaller vein dilations, including spider veins
• Very heavily twisted or knotty varicose veins 
• Varicose veins in the pelvis, near vital organs 

EVLT is also inappropriate in cases where a vascular ultrasound has revealed the presence of an active blood clot condition like deep vein thrombosis (DVT), or localized inflammation within the problematic vein (superficial thrombophlebitis) due to clotting.

Even if ELVT is a good match for your vein problem, our team will advise against it if you’re pregnant or if you have moderate to severe peripheral artery disease (PAD) in your legs, an untreated bleeding or clotting disorder, or a compromised immune system. 

Specialist vein care in Southwest Michigan 

Are you ready to clear unwanted varicose veins from your legs, alleviate associated CVI symptoms, and get back to your active life? With a full scope of minimally invasive vein clearance solutions to offer, we’re here to help. 

Contact your nearest Advanced Vascular Surgery office in Kalamazoo, Allegan, Battle Creek, Coldwater, Sturgis, or Three Rivers, Michigan, today, or use our easy online booking feature to schedule a visit at your convenience.