About Endovenous Laser Thermal Ablation

Total Vein System TVS 1470 Laser Treatment for Varicose Veins

Many men and women who suffer from varicose veins postpone treatment thinking that major surgery, such as a vein stripping, in the only option. Endovenous laser ablation is a minimally invasive, office-based procedure that will free you from the painful symptoms of varicose veins. We have successfully performed thousands of laser procedures using the TVS 1470 vein laser.

Some lasers can rupture the target vein causing swelling, bruising and significant pain. Alabama Vein Center uses this specific vein laser because it has been found to be the most comfortable and effective laser treatment for varicose veins. It is a 1320 nanometer wavelength laser which requires less heat to close the vein than other lasers. It also has a 99% efficacy rate of closing the treated vein. The TVS1470 laser targets water in the vein wall, unlike older lasers that target blood, which makes the procedure much more comfortable with minimal post-op bruising or swelling.

Am I a candidate for Endovenous Laser Thermal Ablation Varicose Vein treatment ?

Patients undergo a comprehensive lower extremity venous ultrasound by a Registered Vascular Technician to determine if they are a candidate for endovenous laser ablation. The endovenous laser procedure is indicated for those patients who suffer with varicose veins or venous ulcerations caused by venous insufficiency (faulty valves) within a portion of the superficial venous system. It is a minimally invasive procedure that is incredibly effective. The endovenous laser treats the underlying source of varicose veins and venous ulcerations.

What Does the Procedure Involve?

Patients are mildly sedated therefore, they must have a driver with them. Upon arrival for the procedure, photographs are taken, the course of any varicose veins are marked on the skin, and an intravenous catheter is placed for the administration of versed (sedative). Supplemental oxygen is administered and monitors for blood pressure, EKG, and pulse oximetry are applied. The leg to be treated is prepped with hibiclens and sterile draped. The access point for the introduction of the laser is identified using ultrasound guidance. The laser fiber is small, about the size of a strand of spaghetti.

The laser fiber is precisely positioned within the target vein using ultrasound guidance. 400 to 500 cc of tumescent anesthesia is then carefully placed circumferentially around the vein using ultrasound guidance. The tumescent anesthesia prevents any sensation of pain while the laser is firing and its presence around the vein prevents the heat of the laser from being transmitted to the skin, muscles, or nerves. The art of the procedure lies in the placement of the tumescent anesthesia. It is the most critical step.

Once the tumescent anesthesia is in place, the proper position of the laser fiber is re-checked and the laser firing is initiated at a pullback speed of .5 to 1 mm/sec. A typical laser run takes about 10 minutes. There is no sensation while the laser is firing. Patients are comfortably sedated throughout the entire procedure. The vein that is treated with the laser is the underlying cause of the varicose veins that are seen at the skin surface. The vein that is treated with the laser is not removed, the body simply absorbs the ablated vein over time. Micro-phlebectomy (the removal of existing varicose veins thru micro-incisions) is then performed on any large and ropey varicose veins seen at the skin surface. The incisions are very, very small and leave little to no mark on the skin. No stitches are required. Sclerotherapy is then done to clear any associated spider veins. It is the combination of all three therapies (endovenous laser ablation to treat the underlying cause of the varicose veins, micro-phlebectomy to remove the existing varicose veins at the skin surface, and sclerotherapy to clear associated spider veins) done simultaneously in a single treatment session that is responsible for our fantastic results. The treated leg is then wrapped with an ace bandage for 2 days followed by a compression hose for 1 week. The hose may be removed to shower and sleep. Any post-procedure pain is easily managed with Motrin or Alleve. Daily activities may be resumed on the second day. Exercise may be resumed on the third day. Patients are able to return to work on the second or third day.

Some temporary skin numbness above the course of the vein treated with the laser is a common occurence. It is not a big deal and typically totally resolves with time. A “pulling” sensation along the course of the vein treated with the laser is also common. The sensation is usually felt 1 week after the procedure. The “pulling” sensation is due to the healing process and typically resolves in 2-3 weeks. Follow-up ultrasounds are done at 2 weeks and 3 months to ensure the vein treated with the laser remains closed. The chance of varicose vein recurrence following successful endovenous laser treatment is less that 1%.

Venous Ulcerations

Venous ulcers are also very effectively treated with a combination of endovenous laser ablation and ultrasound guided sclerotherapy. The abnormal veins that are causing the venous ulcer are identified with an ultrasound exam. The abnormal veins are then destroyed with a combination of endovenous laser and ultrasound guided sclerotherapy. Venous ulcers then typically heal within 1 to 2 months and they rarely recur. Patients are kept in compression hose until the venous ulcer fully heals.

Endovenous Laser Ablation is a procedure with minimal down time, few complications, and a high success rate.  However, you will experience some minor discomfort following the procedure.  Over the 3-4 weeks following the procedure, you will experience several sensations that will change as time goes on.  None of these should be significant enough to keep you from walking or resuming your normal activity. The sensations are part of the healing process and are to be expected.

 

WHAT TO EXPECT FOLLOWING ENDOVENOUS LASER ABLATION

1:  You should not feel intense pain the day of surgery because you have local anesthetic in your leg.  The number one cause of pain the day of your procedure is that the ace bandage is too tight.  This is especially true if the pain is in your foot or heel.  The pain is quickly resolved by simply loosening the ace bandage.

We rarely prescribe pain medication.  We recommend that you take ibuprofen regularly following your surgery to help with the pain and swelling unless you are taking medications that prevent you from taking ibuprofen. Most patients that are experiencing symptoms before their procedure report that recovery from the procedure is less than what they were already experiencing.  You will feel sensations for at least three weeks that are reported as numbness, tingling, mild pain, itching, etc.  However, these feelings are not described as severe pain and are not disabling.  You should be able to function at your normal activity by the third day.  At about 2-3 weeks you will notice a pulling in your groin that may feel similar to a pulled muscle.  This is to be expected and is part of the healing process.

2:  If varicose veins were removed, some minor bleeding may occur the day of surgery.  Put as little weight as possible on the treated leg the day of surgery.  Keep your leg elevated on 2 to 3 pillows.  If you see blood through the bandage, simply elevate your leg and apply pressure.  The bleeding will stop.

3: EXPECT YOUR LEG TO LOOK BRUISED AND SWOLLEN WHEN YOU REMOVE THE BANDAGE:  The bandage will be left in place for two days.  When you remove the bandage, you should be sitting down or reclining. Most patients are not affected by removing the bandage but if you feel dizzy or lighted headed, this will only last for a few minutes.  Your leg will appear swollen due to the amount of numbing fluid placed in your leg to keep you from feeling the laser. Your leg will be bruised.  If you had a vein removed, there will be white gauze pads over the incisions. These can be removed and thrown away.  There will be steri-strips placed over each incision…..no stitches are used. These should stay in place until they fall off or you return for your follow up appointment.  The spider veins that are treated with sclerotherapy will look worse before they look better and they may appear darker for the first two weeks.  If you had a large varicose vein removed, you will have steri-strips over each incision site.  Do not be alarmed by the number of steri-strips. The incisions are very, very small and leave little to no mark on the skin.  Your leg will be bruised, swollen, and the steri-strips will cover the length of the vein removed.

4:  Wearing your compression hose is the number one thing you can do to ensure the optimal result of your procedure and to help prevent complications. The compression hose reduce the amount of bruising and swelling and they increase the clearance of spider veins following sclerotherapy. Wearing the hose and walking as much as possible is optimal.  Compression hose will be worn for five days after the ace bandage is removed on day three. The hose may be removed to sleep and for showering. You may resume your normal activities once you are in the compression hose.

5: The day of surgery you will go home and elevate your leg. Going to the bathroom and kitchen are ok but generally keep your leg elevated.  The following day will be a 50% day and the ace bandage will stay in place.  Once you remove the ace bandage on the third day and begin wearing the compression hose, you can resume your normal activity.  It is fine to return to work on the third day.  You have no limitations, except no heavy weight lifting and no hot baths until you are out of the compression hose. Once you are in the compression hose, the resumption of normal activities will accelerate your recovery.

6: There may be bruising along the course of the great saphenous vein on the inside of your leg or along the course of the small saphenous vein on the back of your leg from the knee to the ankle. There will also be bruising along the course of any varicose veins removed by micro-phlebectomy. Bruising normally resolves in 2 to 3 weeks. 

7:  A bag of fluid called tumescent anesthesia is used during the endovenous laser procedure to surround the target vein and to protect the rest of your leg from the heat of the endovenous laser.  That extra fluid will take up to a week to be absorbed by your body. The swelling may move down your leg and cause swelling in your ankle and foot. Wearing the compression hose and walking will help the swelling resolve.  Typical leg swelling following endovenous laser ablation will resolve within a week. Persistent swelling is rare. However, patients that have a history of long standing ankle swelling may take several months for their swelling to resolve. We typically keep these patients in a knee high compression hose until the swelling resolves.

8: The skin along the course of the endovenous laser in the upper thigh may become red and tender. More laser energy is purposefully put into this portion of the treated vein to ensure its closure. Expect to be a little more tender along the inner thigh from your groin to your knee. The tenderness is to be expected and typically resolves within 3 to 5 days. If the vein to be treated with the endovenous laser is very large or if you are on coumadin, more laser energy is used to ensure closure of the target vein. The tenderness described above is more common under these circumstances. 

9: You may experience some skin numbness along the course of the endovenous laser. Nerves that innervate the skin can be “stunned” by the heat of the endovenous laser. Nerves may also be affected by the removal of varicose veins. The numbness typically resolves over a period of months. The sensory nerves regenerate slowly (1mm/month) and therefore, any associated numbness will resolve slowly as well. Numbness is rarely noticed and when it is, patients do not see it as big deal.

10: You may notice a few lumps that may be a bit tender. These are formed when blood is trapped in a tributary vein after the target vein has been destroyed.  If you have an especially tender area, we may nick the skin overlying the area with a small needle and express the old trapped blood. These lumps are not dangerous but can be uncomfortable. They will eventually resolve on their own, but if the old blood is expressed, they will resolve much quicker.

11: The endovenous laser ablates (destroys) the target vein. The area around the vein is then absorbed by the body. The absorption process results in a “pulling” sensation along the course of the ablated vein in the upper thigh. This is typically felt 2 weeks after the procedure. The sensation resolves on its own within a week or two. Patients do not describe this as pain but do consistently describe it as a “pulling” sensation.  Patients that are very athletic and exercise frequently seem to notice this sensation more often. The sensation is to be expected and is not something to worry about.  You may exercise at the level that feels comfortable to you on the third day as long as you wear your hose. The pulling sensation is no big deal and will not slow you down.

At the Alabama Vein Centers, our physicians have successfully and safely performed thousands of endovenous laser ablation procedures.

Infection following endovenous laser ablation is extremely rare because the numbing fluid that is put into the leg also helps protect against infection.

To protect you from infection we do the following:

  1. Give an antibiotic intravenously through your IV during surgery.

  2. Prep your leg with Hibiclens and create a sterile field.

  3. Provide you with antimicrobial soap to wash with before and following your procedure.

  4. The tumescent anesthesia we use to numb your leg has antibacterial properties.

  5. All incision sites are covered with antibiotic ointment and a sterile dressing.

Blood clots following endovenous laser ablation are extremely rare.

To help prevent blood clot formation we ask that you:

  1. Take ibuprofen regularly following the procedure. You should not take ibuprofen if you are taking coumadin or if you have a history of gastric ulcer. If you are on an aspirin regimen, you can stay on it instead of taking ibuprofen. Do not take ibuprofen and aspirin at the same time.

  2. Wear compression hose as instructed and remain as active as possible.  You may take the compression hose off to sleep and to shower. Compliance with the compression hose is the most important thing you can do to prevent complications and to ensure the success of your procedure.

3.  Remain Active

Contact us with any questions or concerns regarding your varicose vein treatments: