Endovenous Laser Ablation Treatment for Varicose Veins

At The Vein Institute of Toronto, we have chosen Endovenous Laser Ablation Therapy (EVLT™) to treat varicose veins secondary to venous insufficiency because it is the least invasive and most effective treatment available today for varicose veins. EVLT™ is an out-patient procedure, minimally invasive and with only mild discomfort (compared to painful surgery followed by weeks of recovery).

The terms EVLA and EVLT are synonymous and refer to the endovenous laser ablation method that we use at The Vein Institute of Toronto. Our technique of performing EVLT is proprietary, developed at our clinic, based on our patient feedback, our research, and our extensive experience delivering the procedure. We are also an EVLT training site for other physicians (throughout North America).

We apply the laser to the veins that are at the root cause of varicose veins: either the small saphenous vein or to the great saphenous vein. We have selected this method because of its high success rate (93%-95%) and its low rate of recurrence (less than 5%).

To determine whether EVLT is appropriate for you, we offer you a private venous consultation with Dr. Sanjoy Kundu, medical director of The Vein Institute of Toronto. Following a comprehensive physical examination and study of your venous history, we will perform a duplex ultrasound to determine superficial venous reflux, to map out the superficial venous system, and—importantly—to rule out the possibility of deep venous thrombosis.

The result of these examinations is your personalized treatment plan. One copy of your treatment plan is for you, and a second copy is kept on your chart throughout your treatment period to ensure that your goals are respected and fulfilled. If it is appropriate, and if you choose to have us perform the EVLA procedure, we will provide you with complete written instructions for everything you need to do to prepare yourself until the day of the procedure.

We believe in meticulous attention to detail, including sterility and hygiene to ensure your safety and that you receive the highest quality of care.

We use one of two lasers, based on the depth of the vein to be treated, the results of our ultrasound examination, plus your venous history and anatomy. We use the Angiodynamics Venacure™ EVLT™ 1470-nm endovenous laser. The greater wave length (1470 nanometers) reduces the incidence of bruising and discomfort following treatment (with other equipment, discomfort and bruising are far more common). Additionally, recovery time is reduced. The combined benefits of treatment with the Angiodynamics Venacure equal greater comfort and satisfaction for you.

We also use the Dornier D940 laser with its patented lightguide protection system (LPS) that ensures continuous uninterrupted endovenous laser treatment by using a built-in feedback loop. The LPS keeps the laser operating at the ideal temperature without allowing it to ever become hotter than the ideal treatment temperature.

  1. Upon your arrival at our clinic (30 minutes or more before the scheduled time for your treatment), we will give you a gown to wear during the procedure, and we will ask you to remove trousers and/or shorts (but not your under-garments or socks).
  2. We will apply locally (to the area that will be treated) an anesthetic cream that needs about 30 minutes (sometimes longer) to take effect. We will offer you Ativan (a sedative taken by mouth) and/or oxycodone (a pain killer). You are not required to take either of these medications.
  3. We will photograph the area to be treated and produce an ultrasound map. These will be kept in your chart for reference (as the baseline or starting point).
  4. While you are standing, we will apply a tourniquet to the leg(s) to be treated.
  5. You will then lie on the treatment table. We will apply a cleaning solution to your leg(s) and sterile drapes around the area to be treated.
  6. Throughout the procedure, access to the vein to be treated is provided by micro puncture. In preparation for the micro puncture, we will anesthetize (or "freeze", by injection) the site we will use to gain access to the vein.
  7. Using ultrasound for guidance, we will insert a needle into the vein. We will then insert a guide wire through that needle into the vein.
  8. Again using ultrasound for guidance, we will place a sheath over the guide wire where the superficial venous system meets the deep venous system. We insert and position the laser fibre through this sheath.
  9. Using light or ultrasound for guidance, we apply foam Sotradecol solution (sodium tetradecyl sulfate) in a procedure known as branch vein sclerotherapy that shrinks the vein.
  10. Using a mechanical pump, we then apply tumescent anesthetic around the vein. To close the anesthetized vein, we apply the laser and pull it back through the vein (this can take from 2 to 5 minutes).
  11. We apply dressings and support stockings and ask that you walk around the clinic in them for a few minutes to stimulate circulation.

We will provide you with written instructions for everything you need to do in the days following the procedure.

Laser fiber inside the great saphenous vein (at mid thigh).
Upper portion of vein is already shrunk and sealed.
Magnification: vein wall being shrunk by laser energy pulses.
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