Varicose Veins

The Best Way to Treat Varicose Veins

WHAT CAUSES VARICOSE VEINS?

In all likelihood, genetics provide the strongest backdrop to the development of varicose veins. A number of other factors can also promote their development or exacerbate existing varicosities, including: prolonged standing with work, significant weight gain and pregnancy. A significant number of varicosities that occur during pregnancy will resolve postpartum.

WHAT IS EVLT?

EVLT (or EndoVenous Laser Ablation Treatment) is a non-invasive surgical procedure that uses heat energy from a laser source to prevent the abnormal, backward movement of blood in superficial veins that gives rise to large caliber varicosities. The procedure is done using local anaesthesia and the only surgical incision is usually one 2 mm entry point for the required hardware.

WHO CAN PERFORM EVLT?

EVLT is most commonly performed by Board Certified vascular surgeons who have specific training and expertise in venous pathology.  Inspection by the College of Physicians and Surgeons is mandated for EVLT facilities and practitioners. The names and practice locations should appear on the college website.

WHAT IS THE DIFFERENCE BETWEEN VEIN STRIPPING AND EVLT?

EVLT and saphenectomy (vein stripping) offer the same clinical outcomes and have been compared and evaluated in peer-reviewed journals. EVLT offers significant benefit in terms of being more patient-friendly. EVLT averts the need for the numerous incisions that are required for open surgery and because the laser procedure is done under local anaesthesia, it also skirts the need for general anaesthetic and its attendant risks. This is a major advantage for patients who are elderly or have significant comorbidities. The recovery from the EVLT is days rather than weeks with open surgery. EVLT patients can return to work quickly, which may offset the cost for some patients.

IS EVLT PAINFUL?

EVLT is an elegant surgical intervention that provides the minimum possible tissue disruption. There still is some discomfort, although this is usually minimal and the majority of patients find this a very well- tolerated procedure.

WILL THE VARICOSE VEIN COME BACK AGAIN?

Recurrence rates over long periods of time can be in the 30 to 50 per cent range since there are a large number of veins that can undergo the same degenerative changes that allow for the formation of varicose veins. Typically the disease-free interval is quite lengthy and will usually be in the 10-15 year range.

WHAT IS THE RECOVERY LIKE?

Most patients will walk out of the room just as they walked in.  Return to work is usually possible within a few days and reasonable exercise within five to seven days. There sometimes is some bruising
that will always dissipate and surgical scarring is negligible.

WHAT IS THE DIFFERENCE BETWEEN EVLT AND AN INJECTION?

EVLT is a procedure that uses the heat energy from a laser to fuse shut a large caliber, incompetent superficial vein and allow the varicosities it has created to recede, commonly on their own. Injections or sclerotherapy is where a medication is placed within a vein to cause it to become a thin scar under the skin that is not clinically evident.  It is typically used for much smaller veins and has an entirely different clinical indication.

HOW MUCH DOES EVLT COST?

EVLT is not covered under the umbrella of treatments available under OHIP. The cost for one leg is approximately $4,400 for the procedure, taxes and stocking that is worn for roughly two weeks after the procedure.

WHAT ARE THE SIDE EFFECTS?

The side effects include bruising that always resolves; rarely, pigmentation can occur
at the site where the laser penetrates the skin. This usually resolves over long periods of time.  There is a small nerve that can be damaged, which may leave a numb area on the inside of the calf. This usually does not prove to be a significant liability and will correct itself over long periods of time. There is a low probability of recurrence of the veins over long periods of time.

HOW LONG DOES THE PROCEDURE TAKE?

EVLT takes approximately 45 minutes to complete for one leg and roughly 75 minutes for two legs.

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Vitalize Magazine

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