Kentville, NS Summerside, PEI
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Home Veins Endovenous laser treatment

Endovenous laser treatmentEVLT, in our office.

A laser closes a diseased vein from the inside, through a single entry point, under local anesthetic, in about one to two hours.

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Performed by a vascular surgeonRoyal College certified, seven years of specialist training Ultrasound and consult in one visitYour scan is read with you the same day Treating veins since 2007Nova Scotia and Prince Edward Island

Who it is for

Is this right for me?

The short answer is that the ultrasound decides. Here is how we think about it.

EVLT treats the larger veins underneath, the ones that are refluxing: letting blood fall back down the leg instead of carrying it up. Those are the veins behind most of the symptoms people come in with, and they are often not the ones you can see.

It is the treatment your surgeon is most likely to recommend if the ultrasound shows a refluxing saphenous vein. Spider veins and fine surface veins are treated differently, with sclerotherapy or elōs™ laser.

What a vein looks like on the surface is a poor guide. Varicose veins that look dramatic can be straightforward underneath, and quiet-looking legs can hide a significant problem. That is why the duplex ultrasound comes first.

Symptoms we treat

  • Aching legs
  • Heaviness
  • Swelling
  • Night cramps
  • Visible bulging veins
  • Skin changes or discolouration

Any of these, with or without veins you can see, is worth an assessment.

The procedure day

How it works

Step by step, so there are no surprises on the day.

  1. Step 1

    You arrive and the leg is scanned

    Your vein is mapped again on the day, so the surgeon knows exactly where to enter it and what the vein is doing before anything begins.

  2. Step 2

    Topical anesthetic goes on

    A numbing cream is applied 30 to 45 minutes before the procedure. The main discomfort people report is the local anesthetic injection, and this takes the edge off the needle.

  3. Step 3

    The leg is prepared and draped

    This is a sterile procedure, done in our office rather than a hospital operating room.

  4. Step 4

    The fibre is placed

    The surgeon enters the vein at the right spot under ultrasound and passes the laser fibre up inside it. There is no incision and no stitches.

  5. Step 5

    Fluid is injected around the vein

    Called tumescence, this surrounds the vein with local anesthetic and protects the tissue around it from the heat.

  6. Step 6

    The laser is fired

    The laser itself takes minutes. The heat closes the vein along its length as the fibre is withdrawn.

  7. Step 7

    You walk

    You will walk for 30 minutes before getting into a car. Then most patients go back to their normal day.

Start to finish, the appointment runs about one to two hours. The laser is the quick part; the preparation, the ultrasound and the tumescence are what take the time.

Getting ready

Before your appointment

A few practical things that make the day easier.

What to wear

Loose, comfortable clothing you can roll up or change out of easily.

Numbing cream

The topical anesthetic goes on 30 to 45 minutes before the procedure, so arrive in time for it to work.

Arrange a driver

We recommend you arrange a driver. You will be required to walk for 30 minutes after your procedure before getting into a car.

Travelling from out of town

Arrange a driver and elevate your legs while travelling home.

What happens afterward

Recovery

What to expect, and when.

  1. Day 0

    The laser takes minutes; the appointment takes one to two hours. You walk for 30 minutes afterward and in most cases go straight back to normal daily activities.

  2. Days 1 to 3

    A pulling sensation along the treated vein is common in the days after treatment. Minor bruising may appear.

  3. Weeks 1 to 2

    Bruising and any sore, lumpy cord in the treated area usually disappear within one to two weeks.

  4. Weeks 4 to 6

    [CLIENT TO CONFIRM: what should patients expect at the four to six week mark, and is there a follow-up scan or appointment at this point?]

Being straight with you

Side effects and suitability

No treatment is right for everyone, and this is what we tell patients before they decide.

Possible side effects

  • Minor bruising, which usually clears within one to two weeks.
  • A sore, lumpy cord along the treated vein, which also usually settles within one to two weeks.
  • A pulling sensation in the days following treatment.
  • Discomfort from the local anesthetic injection, which is the complaint patients mention most.

Your individual risks are discussed with your surgeon before you agree to anything.

When it may not be recommended

  • You are pregnant.
  • You have had a recent blood clot.
  • You are in poor health or on bed rest.
  • Your ultrasound shows no refluxing saphenous vein. A different treatment is needed, and your surgeon will tell you which.

What to expect

Results and evidence

What the treatment does, and what the published evidence says about it.

The treated vein closes and the blood that was pooling in it diverts to healthy veins. People ask whether losing a vein is a problem: it is not. The vein being treated is diseased and already failing to move blood in the right direction. Closing it improves circulation and reduces symptoms.

Compared with the older operation, ligation and stripping, studies show EVLT is more effective, with significantly less pain and a shorter recovery.

What the research says

Endothermal ablation, the group of treatments that includes endovenous laser, is recommended as first-line treatment for confirmed varicose veins with reflux in the NICE guideline on varicose veins (CG168). A randomised trial comparing laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping was published by Rasmussen and colleagues in the British Journal of Surgery in 2011.

[CLIENT TO CONFIRM: Dr Davidson to approve citation. Suggested: NICE CG168, Varicose veins: diagnosis and management; and Rasmussen LH et al., Br J Surg 2011]

Compare EVLT with adhesive closure, surgery and sclerotherapy

Paying for it

Cost and coverage

The question most people arrive with.

Payment options depend on what is being treated and why. Some vein care has public coverage and some does not, and we would rather tell you plainly at your consultation than have you guess. What applies depends on the clinical picture, and that is exactly what the ultrasound establishes.

Cost, coverage and financing

Endovenous laser treatment, answered

Questions

The questions patients ask us most often.

Does insurance cover the cost?

To date we have found no Canadian health insurance companies that cover the cost of this procedure. We provide information to help you make a coverage request.

What are the advantages over ligation and stripping surgery?

EVLT is a minimally invasive, in-office procedure requiring only local anesthesia, with no stitches. Patients walk out of the office and usually return immediately to normal activities.

Studies show it is more effective, with significantly less pain and a shorter recovery.

Is losing the vein a problem?

No. This vein is diseased and no longer functioning properly. Blood diverts to normal veins, which improves circulation and reduces symptoms.

How long does the procedure take?

The laser itself takes minutes. Preparing and draping, the ultrasound, getting into the vein at the right spot and injecting fluid around it (tumescence) bring the total to roughly one to two hours.

Is EVLT painful?

Usually there is only minimal discomfort. The main complaint is the local anesthetic injection, and a topical anesthetic applied 30–45 minutes beforehand minimizes the needle discomfort.

How long will I be off my feet?

Recovery time is minimal. Most patients walk out of the office after the procedure and in most cases immediately resume normal daily activities.

What are the risks and typical side effects?

The common side effects are minor bruising and sometimes a sore, lumpy cord in the treated area, both of which usually disappear within one to two weeks. A pulling sensation may occur in the days after treatment. Individual risks are discussed with your surgeon.

Will I be able to drive home?

We recommend you arrange a driver. You will be required to walk for 30 minutes after your procedure before getting in a car. Out-of-town patients should arrange a driver and elevate their legs while travelling.

Who should not have EVLT?

Patients who are pregnant, have had recent blood clots, are in poor health or are on bed rest should not have EVLT. Patients without refluxing saphenous veins need a different treatment.

Why trust Valley Medical with your veins?

Our team includes two Royal College certified vascular surgeons, Dr Dion Davidson and Dr Benjamin Heisler, each with seven years of specialized training, plus Dr Greg Butler, a Royal College certified radiologist with more than 30 years of experience, certified ultrasonographers and certified compression stocking fitters.

Also at the vein clinic

Related treatments

Vein care is rarely one treatment on its own.

A liquid agent is injected into the vein through a fine needle, making it shrink and disappear over the weeks that follow.

A painless scan maps the veins in your legs and shows how blood is actually moving through them, and your surgeon reviews it with you in the same visit.

Graduated compression is strongest at the ankle and decreases up the leg, supporting the calf muscle pump and helping blood return toward the heart.

Tired of achy, heavy legs?

Book an assessment and your surgeon will tell you plainly whether this is the right treatment for your legs.

Call 902-678-2121 Book a consultation

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