Like arteries, veins carry blood. Arteries carry oxygen-rich blood from the heart, while veins return blood from the extremities to the heart (to be once again enriched with oxygen). An artery is like an open garden hose, while veins have one-way valves to prevent blood from flowing in reverse.
Complete or partial failure of the one-way valves that are critical to efficient blood flow allows blood to flow backwards through the vein, and to pool. Valve failure (known as reflux, or venous insufficiency) dilates the vein, increases pressure on healthy valves, and results in the twisted, enlarged, unsightly veins that are commonly called varicose veins. Because they reduce the efficiency of blood circulation, eliminating varicose veins is more than an esthetic consideration.
The condition we call "varicose veins" is an extremely common venous disorder (the result of insufficient blood circulation). A weakening of the vein walls causes the circulatory problem. Although we do not know the precise mechanism that leads to the weakened vein walls, we do know the primary contributing factors:
Symptoms of Varicose Veins
Endovenous laser ablation (EVLA) and Radiofrequency ablation (RFA) are techniques that have become available over the last 10-15 years for the treatment of varicose veins.
EVLA can be used to destroy the greater saphenous vein in the thigh or the small saphenous vein at the back of the calf. The equivalent surgical technique is high ligation and stripping of the vein which physically removes the vein. In sclerotherapy chemical foam is injected to damage the vein. In EVLT the veins are destroyed by heating them to a high enough temperature to damage the vein wall. EVLA are alternatives to stripping veins and also replace the disconnection of veins performed through a small incision either in the groin or behind the knee (saphenofemoral and saphenopopliteal disconnection).Read more
Suitable patients being treated with EVLA will generally have greater saphenous vein (along thigh) and or small saphenous vein (back of calf) reflux. They will need a vein that is reasonably straight in order to pass the laser fibre up the vein. It is also important that fluid can be injected around the vein to separate it from the skin and surrounding structures so they do not get burned.
Large visible tortous varicose veins cannot be treated. Thread and reticular veins cannot be treated with RFA or EVLT and are usually best treated with sclerotherapy. Veins being treated need to be reasonably, but not absolutely, straight to enable the catheters to pass.
Surgery remains the gold standard (Enzler, 2010) against which other techniques must be judged and for the first time a randomised trial has compared results in a group of 500 patients from Denmark comparing surgery, EVLT, RFA and foam sclerotherapy. At one year all treatments were effective but the highest technical failure rate was in patients undergoing sclerotherapy (16%) with the lowest in the surgery and RFA/EVLT groups (both at 4.8%). Interestingly the mean pain scores after intervention were highest in the EVLT group and lowest in the RFA group with surgery in between. The mean time off work was between 3 and 4 days. It is clear that surgery and EVLA at least are comparable treatments especially when surgeons use tumescent anaesthesia
Globally, many clinicians are involved in treatment of varicose veins. These include sclerotherapy specialists, dermatologists, appearance medicine practitioners and general surgeons. There is a risk of recurrent varicose veins, whoever is involved in your care and whatever claims they may make. There are two main reasons for this. Firstly the nature of the disease will always put patients at risk. It is a life-long (probably) inherited tendency and over years new veins can appear whatever the treatment, no matter how carefully performed. Secondly, some techniques if not applied correctly may lead to increased risk of recurrence.
Recurrence rates are difficult to compare because definitions of what constitutes recurrence vary from study to study. For instance if the development of thread veins is considered a recurrence, then the majority of patients will develop recurrent veins. This is because thread veins are so common and present in the majority of people over the age of 50 years. The development of larger veins is less common.
Both produce results that are comparable or better than surgery in the trials performed to date.
There is no doubt that they can be effective in the short to medium
Only our experienced consultants who have treated 1000's of satisfied patients Manufacturers do not recommend that beauticians or any other person outside the medical profession perform EVLT
Either in our Centres of Excellence in London or Nottingham. Both are easily accessible by all forms of transport as road, rail and airports are all nearby.
Results of the personal and private consultation (between physician and patient) determine the equipment and ideal protocol for you. Upon arrival for your EVLT appointment, local anesthetic spray and cream are applied to the area to be treated.
The doctor uses ultrasound to map the area to be treated, to identify possible changes since your consultation, and to confirm the optimal protocol. This preparation and confirmation allows us to administer the procedure in the shortest possible time with the least discomfort, and maximal chance of success.
A micro-puncture is made.
The first part of the procedure involves inserting a catheter (fine tube) into the vein to be treated (cannulation). This is usually done by using ultrasound to guide a fine hollow needle into the vein. A wire is then passed into the vein through the hollow of the needle and the needle removed along the wire. The wire is then passing from outside the skin into the vein. The hollow catheter is then threaded on to the part of the wire on the outside and passed along the wire into the vein. Once the catheter is in position the wire is removed. This is known as the Seldinger technique and is a common method of obtaining access to many structures in the body. Ideally the catheter should be positioned down the leg as far as the abnormal flow is present. If necessary a small incision can be made to obtain access to an appropriate vein if this is difficult using the ultrasound technique.
The radiofrequency catheter/laser fibre is then passed up the vein and positioned no closer than 2cms from the saphenofemoral or saphenopopliteal junctions. These are junctions between the superficial and the deep veins and the distance is to minimise the possibility of damage to the deep vein,s but maximise the length of vein to be treated.
It is essential that the vein being treated is separated from the surrounding tissues by injecting fluid around the vein (ultrasound guided tumescent anaesthesia). This for two reasons. Firstly if the procedure is being performed under local anaesthetic with the patient awake the injections prevent pain being felt when the vein is being treated. Secondly, both techniques heat the vein and the heat needs to be dispersed and also prevented from burning all the surrounding tissues including the skin. The liquid that is injected is usually a very dilute local anaesthetic and large volumes are injected, often up to 300mls of fluid per leg.
This is not a painless procedure and if being performed with the patient awake many practitioners will give patients nitrous oxide (laughing gas) or other inhaled pain killers to minimise discomfort.
After the procedure, we will assist you with the application of your medical compression stockings. You will be given post-procedure instructions and you will commence the post-procedure protocol immediately.
Immediate Safe results with minimal risks avoiding need for general anaesthesia The procedure normally takes 20-40 minutes. It is a walk-in, walk-out treatment. You would normally be ready to leave after an hour or two.
Normal day-to-day activity can be resumed the following day. Vigorous exercise, should as gym workouts, riding or cycling should be avoided for the first week.
The laser treatment does not normally need to be repeated. In many patients no further treatment is required. When the veins are extensive these can often be treated by removing them at the same time, or treated in the clinic later with injection sclerotherapy.
Recurrent varicose veinsWill my veins come back?
The veins treated will not normally come back. New varicose veins can develop over time. This is quite variable and may affect some people more than others.Nerve damage
Burning of the skin or surrounding tissues. Burning or heat injury to the deep veinsFailure of the procedure
Bruising and discomfort are fairly common after endovenous laser treatment of varicose veins. However this is usually not particularly troublesome and can be expected to go within a few days. Serious risks, such as deep vein thrombosis - DVT, are very rare. Before any treatment a full discussion of the possible risks and side-effects of any treatment is a routine part of your care.
We are the only clinic that gives all patients 24 hour access to medical staff & regular follow up It is very important that you follow the advice of your practitioner carefully following light treatment for hair removal to reduce the risk of complications. Post-treatment advice may include:
Each patient is different so please call the clinic where a consultant will be able to give an indication of cost.
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