Endovenous laser ablation

Also called EVLA or EVLT. Closing a leaking leg vein with a laser.

What is it?

Endovenous laser ablation is a procedure that closes a leaking leg vein from the inside. Ultrasound guides a thin laser fiber into the vein, usually the great or small saphenous vein. The laser’s heat seals the vein as the fiber is pulled back. Blood then flows through healthier veins.

It treats the vein that is feeding varicose veins. It is not vein stripping, and it is not the same as sclerotherapy, though the two are sometimes done in the same plan. The fiber is removed when the treatment is finished. Nothing is left in the vein.

Why do I need it?

A valve in a leg vein can fail, so blood pools and pressure builds. That can cause:

• Aching, heaviness, swelling, or cramping in the leg
• Varicose veins, skin darkening, itching, or a venous ulcer
• A vein that keeps refilling after surface veins are treated
• Closing the feeding vein can ease symptoms and lower the chance that surface veins return

How do I prepare?

• Medicines: Tell the team about blood thinners and all other medicines. Do not stop them unless you are told to.
• Allergies: Report allergies to numbing medicine, latex, adhesives, or tape.
• The leg: Do not put lotion on the leg the day of treatment. Bring the compression stocking if you were given one. Wear loose shorts or a skirt.
• Eating: You can often eat a light meal unless you are told otherwise. Follow the instructions for your appointment.
• Support: Arrange a ride home. You should not drive yourself after the numbing medicine and sedation used for this procedure.

How is it placed?

• You lie on the table. Ultrasound maps the leaking vein. The skin is cleaned.
• The doctor injects numbing medicine around the vein. This is called tumescent anesthesia. It numbs the area, protects nearby skin and nerves, and empties blood from the vein.
• A thin sheath and laser fiber are placed into the vein through a small nick. Ultrasound confirms the tip is safely away from the deep vein.
• The laser is turned on, and the fiber is pulled back to seal the vein. You may feel warmth or a pulling sensation.
• The fiber is removed. We apply a bandage and compression stocking. Treatment of one vein often takes 45 to 90 minutes. You will be asked to walk before you leave.

Care instructions

• Wear the compression stocking as directed, often day and night at first, then during the day for 1 to 2 weeks. Take it off only to shower unless told otherwise.
• Walk several times a day. Avoid hard exercise, heavy lifting, hot baths, and saunas for about 1 to 2 weeks.
• Bruising, tightness, and a firm cord along the treated vein are common and fade over weeks.
• You may usually shower after 24 hours. Pat the nick dry. Do not soak until the team says you can.
• Keep the follow-up ultrasound. It checks that the vein has closed and that the clot has not entered the deep vein. Desk work is often fine the next day.

What to watch out for

Call your care team promptly if you notice:

• Calf or thigh swelling, redness, or pain that is getting worse
• A blister, burn, or open sore on the treated leg
• Numbness or tingling that is severe, or fever and drainage at the nick
• Bleeding that does not stop with pressure
• Chest pain, trouble breathing, coughing blood, or fainting — seek emergency care