BARIATRIC AND VASCULAR SURGEON
EVLT (EndoVenous Laser Therapy) is a modern method of minimally invasive treatment of leg varicose veins and other forms of venous insufficiency of the lower limbs.
In patients with venous insufficiency, blood in the venous vessels does not flow smoothly. Instead of flowing rhythmically towards the heart, the blood in the lower limb veins is overwhelmed and retracted, which is what doctors refer to as venous reflux. The blood column covering the light of the vein leads initially to the widening of the vein and finally to the formation of varicose veins. The longer the disease lasts, the larger and more varied the varicose veins. In addition to causing varicose veins, reflux of blood in the veins is responsible for a number of other pathological phenomena in soft limb tissues, which is reason of a number of ailments such as pain, fatigue, and swelling.
The method of treatment, commonly referred to as a "laser" by patients, involves the use of laser energy to close the venous insufficiencies within the lower limbs. At the tip of the laser fiber, inserted into the light of the ineffective vein, a high temperature is created, which acts on the vein wall from the inside, leading to immediate closure of the vessel, and secondarily to its fibrosis. In a vessel closed this way, the blood stops retreating, but continues to flow with other viable veins.
At the beginning of the procedure, the surgeon uses the ultrasound head to look for the lowest part of the diseased vein, in order to enter a laser fiber into it, also with the use of ultrasound. What is important, the laser fiber has a diameter of about 1 mm, so the surgeon must only puncture the vessel. Subsequently, while observing a laser fiber in the ultrasound image, the surgeon inserts it usually into the groin region (in the treatment of the great saphenous vein) or in the vicinity of the popliteal fossa (in the pathology of the little saphenous vein ). Respectively, under the control of the ultrasound image, the vein and surrounding tissues are anesthetized with local anesthetic so that the surgery can be performed painlessly. At this point, the surgeon comes to the main part of the procedure. Upon activation of the laser, a high temperature is created at the tip of the laser fiber, which, acting on the vessel wall from the inside, leads to its immediate closure. Withdrawing the laser fiber slowly from the vein, the surgeon closes the entire insufficient vessel. Secondarily closed vessel is fibrotic, and only the connective tissue remains at the place of the earlier vessel.
The entire procedure ends with putting a dressing at the location of the laser fiber insertion and bandaging of the limb with elastic bandage, as well as putting on a compression stockings.
Due to the fact that the procedure is performed under local anesthesia, it is practically painless, and the patient can on his/her own come down from the operating table immediately after the surgery.
Immediately after the procedure, the patient returns home and can perform everyday activities. In the first period, pain may occur, but its intensity is relatively small and it is sufficient to take basic analgesics such as paracetamol or ibuprofen, commonly available without a prescription.
It is recommended to wear compression stockings within 1 month after surgery to achieve a better cosmetic effect.
This minimally invasive procedure of EVLT allows treatment of more than one vein. Simultaneous treatment of both lower limbs minimizes the duration of treatment and significantly reduces the cost of therapy.