What is Endovenous Vein Treatment?
Endovenous means ‘inside the vein’ – in the context of surgery for veins it encompasses a variety of new techniques for fixing veins which are ‘minimally invasive’ – in other words where the surgeon repairs the faulty vein by procedures which don’t require any major incisions in the leg. Over the last 10 years endovenous techniques have been replacing the traditional vein surgery operations and can now be considered the ‘gold standard’ of venous surgery.
In general terms the whole of surgical practice has been moving to more minimally invasive techniques over the last 20 years – surgeons have found that ‘keyhole type’ operations of all types have significant benefits to patients in terms of less post operative pain, faster recovery from surgery and a quicker return to normal activities than the ‘traditional’ open surgical techniques.
These advances have come about because of improvements in technology relating to the way we do operations. Most minimally invasive operations are performed through tiny incisions in the patients skin instead of large cuts and the operative procedure is carried out from the inside of the body.
Essentially surgeons are constantly trying to achieve the benefits of surgery (ie fixing or removing a faulty organ) without the bad bits of surgery (big incisions, pain and scars).
Endovenous surgery is the minimally invasive way to treat varicose veins – for most of the techniques an ultrasound machine is used to allow the surgeon to ‘see’ the leaking vein through the skin – which cant be seen with the naked eye.Under ultrasound guidance the operative instruments are placed inside the problem vein via tiny nicks in the skin and the vein is fixed from within rather than by stripping it out of the leg.
All the Endovenous techniques try to block the leaking vein. This is done by a variety of approaches depending on the specific technique used – all have advantages and disadvantages.
EVLT laser treatment and radiofrequency ablation (or VNUS closure) are the commonest operations in practice today. They are essentially very similar – a probe is placed inside the vein and heat treatment is used to destroy the inside of the vein wall to make the vein itself block and stop leaking. The main difference is that the laser uses amplified light energy to apply the heat source and the radiofrequency probe uses electrical energy. They both work well and have been in practice and development for about 15 years at the time of writing.
Other endovenous techniques include Foam sclerotherapy, Clarivein and the latest glue technologies.
Foam sclerotherapy uses a chemical mixed up with air to also burn the vein from the inside – in this case the burn is created by the chemical rather than by a heat source. It can work quite well but there are still some people who are concerned about injecting large amounts of air into the circulation and foam sclero has a disadvantage of a high rate of recurrence. (ie the veins tend to come back quite frequently).Clarivein is a new technique which closes the vein by a combination of mechanical irritiation and chemical burn – the chemical used is the same one as for foam sclerotherapy but no air is used so it is considered to be safer. Clarivein has impressive results in early studies and it is certainly less painful than the heat based techniques but we are waiting for the longer term follow up studies to see if it works as well as lasering.
Glue is the latest technique to be trialled and is still in the early stages of development, so although it is an interesting advance it is still too early to say whether it will have a significant place in vein surgery of the future.
Instead of the old ‘high tie and strip’ method involving a lot of cuts in the leg; EVLT can be done entirely under local anaesthetic with no surgical incisions. The post-operative discomfort and bruising is less than with traditional surgery and patients return to work faster than after traditional surgery.
For that reason it has now become the treatment of choice for many leading specialist varicose vein surgeons and long-term follow-up data now shows EVLT also has less recurrence than the old style ‘high tie and strip’ surgery.
How is EVLT done?
- The vein to be treated is accessed though a tiny incision (2mm). The laser fibre is passed into the vein and positioned in the correct place with guidance from an ultrasound probe.
- Local anaesthetic is injected around the vein before activation of the laser. When the laser is turned on, the fibre is slowly withdrawn down the leg.
- As the fibre is withdrawn, the laser energy burns the inside of the vein, sealing it from the inside.
- The treated leg is measured and a compression stocking fitted before the patient goes home.
The operation can be carried out as a day case. Patients can walk around immediately after the operation. The whole procedure takes from about 45 minutes to one hour per leg to complete.
What are the advantages of EVLT as opposed
to conventional surgery?
- No scarring
- No cut in the groin
- Less bruising
- Faster recovery
- Can be done under local anaesthetic
- No overnight hospital stay needed
- Less recurrence of varicose veins
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