Endovenous Laser Ablation

Dr. Manning and Dr. Adams use the CoolTouch 1320 nm laser system to perform the endovenous laser procedure.

Are you a Candidate?

Patients undergo a comprehensive lower extremity venous ultrasound by a Registered Vascular Technician to determine if they are a candidate for endovenous laser ablation. The endovenous laser procedure is primarily for those patients who suffer the symptoms of varicose vein disease caused by significant venous insufficiency (faulty valves) in the superficial venous system. It is a minimally invasive procedure that is incredibly effective. The endovenous laser treats the underlying source of varicose veins and venous ulcerations.

What Does the Procedure Involve?

Patients will be mildly sedated therefore, they must have a driver with them. Upon arrival for the procedure, photographs are taken, the course of any varicose veins are marked on the skin, and an intravenous catheter is placed for the administration of versed (sedative). Supplemental oxygen is administered and monitors for blood pressure, EKG, and pulse oximetry are applied. The leg to be treated is prepped with hibiclens and sterile draped. The access point for the introduction of the laser is identified using ultrasound guidance. Local anesthesia is used prior to the introduction of a needle under ultrasound guidance followed by a guidewire, introducer, and finally the laser fiber itself.

The laser fiber is precisely positioned in the target vein using ultrasound guidance. 400 to 500 cc of tumescent anesthesia is then carefully placed circumferentially around the vein using ultrasound guidance. The tumescent anesthesia prevents any sensation of pain while the laser is firing and its presence around the vein prevents the heat of the laser from being transmitted to the skin, muscles, or nerves. The art of the procedure lies in the placement of the tumescent anesthesia. It is the critical step in the procedure. The risk of complications is significantly reduced by the proper placement of the tumescent anesthesia.

Once the tumescent is in place, the proper position of the laser fiber is re-checked and the laser firing is initiated at a pullback speed of .5 to 1 mm/sec. A typical laser run takes about 10 minutes. Micro-phlebectomy (the removal of existing varicose veins thru micro-incisions) is then performed on any large and ropey varicose veins. Sclerotherapy is then done to clear any associated spider veins. It is the combination of all three therapies (endovenous laser ablation, micro-phlebectomy, and sclerotherapy) in a single treatment session that allows for our fantastic results. The treated leg is then wrapped with an ace bandage for 2 days followed by a compression hose for 1 week. The hose may be removed to shower and sleep. Any post-procedure pain is easily managed with Motrin or Alleve. Daily activities may be resumed on the second day. Exercise may be resumed on the third day.

Some temporary skin numbness above the course of the ablated vein is a common occurence. It is not a big deal and typically totally resolves with time. A "pulling" sensation along the course of the ablated vein is also common. It is usually felt 1 week after the procedure. The "pulling" sensation is due to the healing process and typically resolves in 2-3 weeks. Follow-up ultrasounds are done at 2 weeks, 3 months, and 6 months to ensure the target vein remains closed. Our experience using the CoolTouch endovenous laser is a 98% closure rate at the 6 month follow-up.

Are There Any Potential Complications?

The one potential complication to be acutely aware of is the formation of a deep venous clot. The complication is very rare following endovenous laser ablation (<1% nationally, <.07% in our clinic) and is almost completely prevented by walking (resumption of normal activities) and compliance with wearing the ace wrap and compression hose as directed. The thing to look out for is a firey red, hot, and painful leg. If this occurs, call Dr. Manning on his cell phone immediately and he will handle the problem. Again, this complication is extremely rare following endovenous laser ablation but it is a potentially dangerous occurrence so it is important for each patient to know how to recognize it. A more common occurence is for the patient to notice some skin numbness along the course of the laser run. The numbness typically totally resolves within 1 to 2 months.

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