Varicose veins: Endovenous laser treatment

Endovenous laser ablation (EVLA) has been developed as an alternative to surgery of great saphenous vein (GSV) and short saphenous vein (SSV) in an attempt to reduce morbidity and improve recovery time. EVLA can be performed in an outpatient special procedure room in the hospital. EVLA works by means of thermal destruction of venous tissues. Several wavelengths can be used: 810, 940, 980, 1,064, 1,320, 1,470, and 1,500 nm. Heating decreases with tissue depth as absorption and scattering attenuate the incident beam. Consequently, the laser beam must heat the vein wall and not the blood. Before performing EVLA, the vein lumen must be emptied out of its blood by using leg elevation (Trendelenburg positioning), manual compression, and perisaphenous subcutaneous tumescent saline solution infiltration. The appropriate LEED (linear endovenous energy density) must be selected as a function of the diameter of treated segment. Veins greater than 9-12 mm diameter are difficult to treat even when using higher energy. In a general manner, side effects are energy dependent. LEED superior to 100 J/cm is very often associated to superficial burns and palpable indurations.