Endovenous Laser Ablation
Endovenous laser ablation (EVLA) is a minimally-invasive procedure which is designed to close abnormal saphenous veins from the inside. The saphenous veins are long, straight veins on the front and back of the legs. They are often not visible, but when they are not functioning properly, they are frequently the source of other varicose veins. Since abnormal saphenous veins are the root of the problem, treatment of these veins is important in order to prevent recurrent varicose veins and improve symptoms.
EVLA is performed in the office (not the operating room) with ultrasound guidance. The laser fiber is carefully inserted into the vein through a catheter and precisely positioned. Once the laser fiber is positioned correctly, local anesthetic is carefully placed around the vein to numb it for safety and comfort. The laser is then used to treat the vein in a controlled, reproducible way. You should be pain free during the laser ablation. Following the procedure, a medical grade compression sock will be placed on the treated leg and you will be asked to walk for 60 minutes prior to driving.
While the procedure is generally well-tolerated, some patients prefer to take a prescription medication in order to ease their anxiety. If you choose to request this medication, please feel free to speak with Dr. Jensen at your preoperative appointment. Please note that patients who take this medication must bring a driver, as the medication can impair judgement and reaction time.
After the procedure, you may experience bruising, tenderness, lumpiness, staining of the skin, and redness which will lessen with time. You may take ibuprofen 400 mg (if not allergic and no kidney problems) up to three times a day for one week following the procedure for pain. Numbness, particularly on the inner part of the lower leg, is a relatively common side effect and usually improves over time. More serious complications, such as deep vein thrombosis (blood clot in the deep veins), pulmonary embolism, allergic reaction, or infection can also occur, although they are rare. If you suspect any serious complication, please feel free to contact the office at any time.
Watch the EVLA procedure:
Frequently Asked Questions
Does the endovenous laser ablation procedure hurt?
EVLA is generally well-tolerated by our patients, and we do our best to make the procedure as comfortable as possible. Local numbing injections are used to numb the vein and protect the structures near the vein. These injections can be mildly to moderately painful, but most patients tolerate these very well.
Do I need antibiotics for this procedure?
Some patients may benefit from pre-procedure antibiotics. Dr. Jensen will review your medical history at your initial consultation to help you determine if antibiotics are recommended prior to your procedure.
How long does the procedure take?
Generally, the EVLA procedure takes 30-60 minutes.
How should I prepare for my appointment?
Several easy steps can be taken to ensure a positive experience and an excellent outcome. Make sure to get adequate rest prior to the procedure. Additionally, make sure to drink plenty of fluids on the day of the procedure (as long as there is no restriction on your fluid intake). Do not wear your compression stockings on the day of the procedure, as this can make it more difficult to insert the laser fiber. Eat a normal meal (breakfast or lunch) as you would on any other day. Take your prescription medications as per routine.
Please tell us if you have a history of blood clots, require antibiotics for regular dental cleaning, are taking any blood thinners, or if you may be pregnant.
We wish to ensure that your questions are answered and that you are comfortable with the procedure. Dr. Jensen is happy to answer your questions at any time, including those that arise during the procedure. He will walk you through the process step by step so that you will feel confident that you are receiving the best care possible.
What should I bring to my appointment?
Bring or wear the following items to your appointment:
- Compression socks: We recommend that you bring all of your compression socks so that we will be able to choose the most appropriate one for you to wear following your procedure. If you decide to purchase compression socks somewhere besides Clarity Dermatology, we recommend that you bring them in prior to any procedures to make sure that they will provide adequate compression.
- Comfortable walking shoes and weather-appropriate clothing: Following your procedure, we will ask you to walk for 1 hour. Patients often prefer to walk outside. However, you may also walk inside, if desired.
- If you are taking anti-anxiety medication:
- Arrive 30 minutes prior to your appointment time.
- Bring you pre-ordered pill(s) with you. Do not take at home.
- Arrange for a driver to drive you home after the procedure.
- Antibiotic medications, if indicated: At the preoperative appointment, Dr. Jensen will help you determine if you need any preoperative antibiotics.
Should I continue taking my medications on the day of the procedure?
In general, you should continue to take your medications as directed by your prescribing physician. Do not stop your medications unless told otherwise, as it is rare that you would need to change your daily regimen. If you have specific questions, please bring them up at your initial consultation or preoperative appointment. Dr. Jensen will review your medication list with you and make recommendations based on your particular health history.
What are the post-procedure care instructions?
- Following the procedure, we will help you place an appropriate compression stocking. Keep your compression stocking on for 3 days, 24 hours per day. After these 3 days, wear your compression stocking for an additional 10 days during the day, for a total of 13 days.
- We recommend that you walk for one hour immediately after the procedure and prior to leaving in your vehicle. You do not need to report back to us after your walk unless you experience a problem (i.e., severe pain, bleeding, or any other concerning symptom).
- Remove the pressure dressing that was applied at the site 1 day following the procedure.
- Walk every day for an hour.
Are there any limitations following the procedure?
- You may exercise as long as it does not increase your abdominal pressure (such as weight lifting, high impact aerobics, running, horseback riding, etc). These activities may be resumed 2 weeks following the procedure.
- Do not travel (long flights or car trips) for at least 2 weeks following the procedure. If travel is unavoidable, we recommend walking for 10-15 minute for every hour of travel.
- Avoid saunas or hot baths (more than 100° F) to prevent reopening of the vein for at least 2 weeks.
- No heavy lifting (more than 20 lbs) for at least 2 weeks.
What should I do if I am having tenderness following the procedure?
It is relatively common to have mild post-treatment tenderness in the treatment area. If you experience significant discomfort, please call us for directions. Often, tenderness can be alleviated with a combination of ibuprofen (Advil, Motrin) and acetaminophen (Tylenol). Warm compresses can also be used to decrease pain. However, if you have any concerns, we encourage you to contact us.
Is there any follow up needed after the procedure?
While complications following EVLA are rare (<1%), we recommend close follow-up after your procedure. An ultrasound examination is generally recommended 1 week following the procedure to rule out a blood clot. If you have multiple planned procedures, we will try to combine appointments to minimize time and cost to you.