Endovenous Laser Treatment (EVLT), a minimally invasive, non-surgical procedure performed under local anesthetic in a physician's office, may be the optimal choice for the treatment of saphenous vein reflux, a recent study published in the Journal of Vascular and Interventional Radiology indicates.
"To treat varicose veins, for the major problems, we normally would recommend surgical ligation and stripping of the varicose veins," said Dr. Rolando Corpus, phlebologist and vascular surgeon at the Center for Vein Care, and on-staff consultant in the department of surgery at North York General Hospital in Toronto.

NO RECOVERY NECESSARY FOR PATIENTS UNDERGOING EVLT PROCEDURE

"That requires hospitalization, general anesthetic, multiple scarring, prolonged recovery time, time lost from work and a lot of pain. [EVLT is] an office procedure, done under local anesthetic," he added.

"There is virtually no recovery time needed, as the patient is able to walk immediately after the procedure. There's immediate relief of symptoms, there is little or no pain. And it carries the 98 per cent success rate."

In a recent trial Dr. Robert J. Min, developer of EVLT, and a team of researchers, studied the long-term follow-up results of EVLT for great saphenous vein (GSV) reflux caused by saphenofemoral junction (SFJ) incompetence.

A total of 810-nm diode laser energy was administered percutaneously into the GSV in 499 GSVs of 423 patients with varicose veins through a 600-micron fiber.

Under guidance of ultrasound, tumescent anesthesia (100 to 200 mL of 0.2% lidocaine), was delivered. Clinical and duplex ultrasound follow-up occurred at one week, one month, three months, six months, one year, and yearly thereafter to assess treatment efficacy and adverse reactions.

Almost all patients were treated for associated tributary varicose veins and secondary telangiectasia through compression sclerotherapy at follow-up.

Dr. Min and colleagues observed sucessful occlusion of the GSV, defined as absence of flow on color Doppler imaging, in 490 of 499 GSVs (98.2) after initial treatment.

Of 121 limbs (93.4%) followed for two years, 113 remained closed, with the treated portions of the GSVs not visible on duplex imaging.

SOME PATIENTS EXPERIENCED BRUISING, TIGHTNESS ALONG LEG

Most recurrences occurred before three months, and all recurrences occured before nine months.

Twenty-four per cent of patients experienced bruising, and 90% of limbs showed tightness along the course of the treated vein.

Researchers observed no skin burns, paresthesias, or cases of deep vein thrombosis. Amongh 499 limbs treated with endovenous laser, long-term results showed a less than 7% recurrence rate at the two-year follow-up point.

The team concluded that EVLT offered the same benefits as surgery, ultrasound-guided sclerotherapy, radiofrequency ablation and other treatments available for GSV reflux with lower risk of complications and without requiring general anesthesia. (J Vasc Interv Radiol 2003 Ag; 14(8):991-996.)

BENEFITS: NO ANESTHESIA, NO PAIN, NO SCARRING, LESS COST

"The laser treatment is an outpatient procedure that offers many benefits over traditional surgery including little to no pain, no general anesthesia, no scars, less cost, and rapid recovery time," said Dr. Min, interventional radiologist and director of Weill Cornell Vascular in New York.

The procedure was approved by Health Canada in March 2003 and there are now 13 locations and 22 certified physicians offering EVLT across the country.

"When the valves are damaged, [they are] not able to hold a column of blood, so it seeps downwards, and that's called reflux," said Dr. Corpus, who has been performing the procedure since May 2003.

"That's what causes all the symptoms of varicose veins. It's the pooling of blood in the legs. EVLT is a minimally invasive procedure, where we insert a laser fiber, into the vein from the region of the knee and thread it up to the groin," he added.

"We do this under ultrasound guidance. And then we use an anesthetic solution to bathe the vein and surrounding tissues so the patient doesn't feel it. Once we're in the position we activate the laser and the laser energy causes the vein to close. It's the heat from the light that closes the vein and stops the backwards flow [of blood].

OTHER CAUSES INCLUDE OBESITY, PREGNANCY, AMBULATORY JOBS

An appropriate candidate for EVLT would be anyone with GSV reflux, incompetence of the greater saphenous vein demonstrated by duplex ultrasound imaging. Patients must be at least 18 years of age and have chosen EVLT over other methods of treatment.

"This is a one shot procedure, but it is frequently complemented by sclerotherapy," said Dr. Corpus.

"It is also complemented with the use of compression stockings. They prevent blood from stagnating in the legs."

Dr. Corpus adds that, approximately 70% of the time, genetic factors contribute to the development of GSV reflux, as do obesity, ambulatory occupations, occupations in which people seated for long periods of time, and pregnancy.

Pumping one's legs through regular exercise or brief periods of walking throughout the day can help prevent the development of GSV reflux.