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Endovenous Laser Therapy - EVLT

To make an appointment with Mr Braithwaite, Consultant Vascular Surgeon in Nottingham click here   

What is EVLT?

EVLT is the name for a new technique to remove varicose veins?

How does it work?

A fine tube (catheter) is passed through the skin near the knee and then threaded up the diseased long saphenous vein. The tube is attached to a laser power unit that heats up the end of the catheter. The heat seals the walls of the vein so that no blood can flow through it. The operation is normally done under local anaesthetic but can be done under general anaesthetic.

How is EVLT different from standard surgery?

If you have varicose veins then one of the causes is normally an incompetent long saphenous vein (LSV). Research has shown that it is important to remove this vein to treat varicose veins and reduce the chance of them coming back soon. Standard surgery frequently requires a cut in the groin to disconnect the LSV and then it is removed by a stripping device. This can cause dramatic bruising. EVLT avoids the need for a cut in the groin and there is minimal bruising. This means people who have EVLT can usually return to normal activity sooner than those who have standard treatment.

Is EVLT better than standard surgery?

It is now thought that EVLT is as good as traditional surgery for long saphenous varicose veins.

Doctors normally want to know the results of scientific studies before they are happy that one treatment is better than another. A randomised trial of EVLT and the standard technique has been done by surgeons in Leeds. This has shown that it is a valuable method for treating varicose veins.

We do not know what the recurrence rates of varicose veins after EVLT are. Only time will tell.

Is everyone with varicose veins able to have EVLT?

No. Some people have large, winding veins that are not suitable. Your Vascular Surgeon will be happy to discuss whether your veins are suitable for EVLT. Our research suggests that about 70% of people with varicose veins can be treated with EVLT.

Is EVLT all I need for my veins?

EVLT will remove the major superficial veins, including the LSV and anterior thigh veins. It is, however, usually necessary to have the bulging veins around the calf removed through small cuts called avulsions or have them treated by injections followed by bandages.

What are the advantages of EVLT?

Apart from the lack of a cut in the groin, there is minimal bruising of the leg and people can return to normal activities more quickly?

What is the catch?

EVLT uses special catheters that cost about £200 each. During the operation, an ultrasound machine has to be used and a technician is required to control it. The room where the procedure is done has to be specially suited for laser treatments. The operation can take longer than the standard method.

Is EVLT an approved method?

EVLT has been approved by the Government agency NICE. At the moment it is not available on the NHS because of the costs involved. The study you are being asked to take part in may help to show that it should be used in the NHS.

Are there likely to be any future problems if I have EVLT?

All patients who have varicose vein surgery have a chance of wound infection, nerve injury and recurrence of the veins. The only additional risk that may occur with EVLT is the development of a cord of tissue in the thigh where the LSV has been treated. This has been seen in patients who had endoluminal diathermy, an older and less efficient method than EVLT. If the cord develops, patients feel a tightness in the thigh when they cross their legs.  This usually gets better with time.

Is EVLT all I need for my veins?

EVLT will remove the major superficial veins, including the LSV and anterior thigh veins. It is, however, usually necessary to have the bulging veins around the calf removed through small cuts ( under anaestesia) called avulsions or injections called sclerotherapy. 

Are there any complications associated with EVLT?

Are there any alternatives toEVLT?

Apart from conventional surgery, varicose veins can be treated with a technique called VNUS. 

Varicofoam, foam injection of varicose veins is another new technique used by Mr Braithwaite. 

Venocuff valve repair is a technique that Mr Braithwaite plans to introduce.