Endovenous Laser Treatment (ELT)

Introduction

Lasers have been used for numerous medical applications throughout the body. A technique utilizing laser energy delivered endovenously (directly inside the vein) via a small laser fiber has been developed to treat varicose veins. Endovenous laser therapy is performed under local anesthesia in our office. There is little to no scarring and a relatively short recovery period after the procedure. The procedure is called Endovenous Laser Therapy (ELT); it is an outpatient procedure which means you can resume your normal activities almost immediately.

Procedure Description

Your doctor will perform a duplex ultrasound examination using a machine that allows the doctor to visualize the blood vessels and record their size and shape. He will “map” out the venous system so he can know where all the leaky points are. Photographs of the therapy areas will be taken.

On the day of your procedure, you will: be asked, if you would like to have a low dose of the muscle relaxant Xanax. This medication will not only relax you but also the muscle in your leg. This helps from having your leg muscles tense up during the procedure.

You will also need to have someone come with you to drive you home. You should not drive for 24 hours. You will also need to have with you, your thigh-high compression hose. These are a necessity on the day of your procedure.

During the procedure, we will give you special eye goggles to protect your eyes against accidental exposure to laser light. Next, the therapy area will be anesthetized with a common anesthetic, Lidocaine. A sterile fiber will be inserted into the vein and positioned under ultrasound guidance. Laser energy will be delivered to selectively treat the target vein. Our staff will place your thigh high compression stocking on your leg, it must be worn for one week following therapy. For the next 7 days, you will not take the stocking off. You may shower with it on. If needed you may use a hairdryer to dry the stocking. If the elastic stocking does not stay up properly, you may wear regular pantyhose over them. Another alternative may be to wrap an ace bandage around the top to help hold them up.

You will return to the office in 3 to 10 days and the doctor will examine the treated area. Doppler and duplex ultrasound evaluation will be done and additional photos may be taken. Repeat endovenous laser therapy (ELT) using modified parameters may need to be done at the discretion of the doctor. Further therapy with compression, phlebectomy and/or sclerotherapy (injections) may also be needed.

Risks and Discomforts

If you undergo endovenous laser therapy (ELT) for varicose veins, your symptoms of varicose veins may improve, remain the same, or worsen. There are several uncommon local side effects that could occur with ELT. These include bruising, discoloration and inflammation, a large amount of swelling. They are usually temporary and will usually resolve in a few weeks to a few months. There are a few potential serious side effects that theoretically may occur, such as blood clots, perforation of the vein or breaking of the fiber inside the vein. Some other after-effects that may be experienced may be mild itching or soreness under your stocking. If you have large veins being treated, you may have some acing along the treated veins. You may use Benadryl for relief from itching. You may also take Tylenol for relief from soreness. Both are available over the counter. Avoid aspirin, ibuprofen and NSAIDs.

Please contact our office if you have any of the following symptoms:

• Marked swelling
• Severe pain
• Blue or excessively cold feet
• Allergic rash or blisters

After Therapy

It is highly recommended to be as active as possible. You should walk as much as you can. A brisk 30minute daily walk will be a good start. You may use a treadmill if possible. You may exercise after the first 24 hours. We do not recommend jogging, high impact aerobics, sit-ups, leg lifts, squats or lifting over 15 pounds for the period of time that you are wearing your compression hose. Make sure you wear your thigh-high compression stocking continuously for the first 7 days. Once you have returned to our office for your post-operative ultrasound, you will be able to take the hose off at night. You will continue to wear your hose during the day for the next month.

Potential Complications Of Not Having Therapy
The potential complications of not undergoing therapy are most often limited to merely a worsening of the condition with an increase in the number of veins or enlargement in the existing veins. In cases of large varicose veins, spontaneous superficial phlebitis or bleeding may occur. Patients with varicose veins associated with underlying venous insufficiency may develop ankle swelling and/or skin changes (eczema, hyperpigmentation, ulceration). There is an increased risk of getting blood clots if you have varicose veins.

Alternative Treatments

Since varicose veins and spider veins are not necessarily life-threatening, therapy is not mandatory. Some patients may get adequate relief of symptoms by wearing graduated compression stockings. Alternative therapies for varicose veins include surgery, ambulatory phlebectomy, ultrasound-guided sclerotherapy (Injections),
a combination of these therapies.

Potential Benefit

The potential benefits from the procedure are reduction in the size or closure of the treated varicose veins and improvement in your symptoms associated with the varicose veins. There is no guarantee that you will receive any medical benefit as a result of endovenous laser therapy (ELT).

Insurance

If your insurance requires prior authorization for this procedure, our office will handle this for you. Some insurance companies may also require a pre-determination in an effort to guarantee payment for this service. Our office will also take care of this for you. It may take up to 4 to 6 weeks for one or both of these to be handled. Our office will contact you to arrange for your procedure as soon as this process is completed. Every effort will be made to work with your insurance company and you to get the procedure scheduled.

After reading this material, should you have any questions or concerns, please contact our office.