TORONTO – Doctors across the country are embracing the relatively new procedure of laser treatment for varicose veins.
Approved by Health Canada since March 2003, currently 13 sites and 22 certified physicians in Canada provide endovenous laser treatment (EVLT). The outpatient procedure delivers a thin laser via a catheter - about the width of an angel-hair pasta noodle—to permanently collapse and seal shut damaged saphenous veins.

A freezing solution is delivered around the entire length of the vein to be treated and then the laser fibre is pulled back, sealing the vein as it is removed.

EVLT treats the main superficial veins. Most visible varicose veins may be tributaries of these main veins. It takes six to eight weeks for these branches to shrink and in many cases disappear completely.

"I have been treating varicose veins for 15 years and I always wondered if there was a better way to remove them," said Dr. Alan Lossing, associate professor in the department of surgery, vacular surgery division, and co-director of the vascular lab at the University of Toronto and St. Michael's Hospital.

He said EVLT offers a more patient-friendly alternative to vein stripping.

"Patients like the fact that it doesn't include general anesthetic, just local. They also like that the procedure can be performed in a clinic. Following SARS, the importance of not having to admit the patient into a hospital can't be underestimated," said Dr. Lossing. "For most people, the recovery only requires a bit of walking around."

According to a study published in the August 2003 issue of the Journal of Vascular and Interventional Radiology, EVLT has a 98% success rate and a recurrence rate of just 9%. Surgical ligation and stripping carries a recurrence rate of about 10%. EVLT is not covered by insurance.

Dr. Lossing performs about four or five EVLT procedures a month in his Toronto clinic, even though he has the capability to do four per day.

Not every patient is a candidate for EVLT, he said. It is not covered by the province's drug plan or most insurance plans so most patients opt for surgery instead.

The cost per leg is about $3,000. "I've approached hospitals and insurance companies about covering EVLT but they see it as a cosmetic issue and don't want to open that door," explained Dr. Lossing, who says 10% of his patients have the procedure due to medical reasons.

Dr. Rolando Corpus, who runs the Centre for Vein Care in Toronto, said he has performed laser treatment on as many as 21 patients in one month. Since offering it last May, he has treated more than 130 patients using the technique.

Vein stripping traumatic
"Stripping is a very brutal process with a lot of bruising. It is very traumatic to the surrounding tissues," said Dr. Corpus. "With EVLT, a patient can be back to work within days."

Dr. Lossing and Dr. Corpus are training doctors across Canada on EVLT for Sigmacon Health Products, the Toronto-based distributor of the technology in Canada.

The laser costs about $50,000, plus roughly $40,000 for the ultrasound.

EVLT is not meant to replace more traditional treatments like vein stripping, they point out. "But laser treatment is revolutionizing the way we treat varicose veins," said Dr. Corpus. "I haven't seen anything in the industry this promising in over 20 years."