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Treatment of varicose veins Using endovenous laser
ablation [evla]
Varicose veins occur when the valves in the superficial
venous system fail and allow blood to flow backwards down
the leg. This causes increased pressure in the veins which
then become tortuous and prominent, resulting in varicosities
which cause discomfort and aching. In severe cases varicose
veins can produce leg swelling, marked skin pigmentation
and ulceration.
Traditional surgical correction of varicose veins involves
an incision in the groin to locate the main superficial
vein which is then divided. Following this the vein is
stripped out of the leg and removed through a number of
small cuts [avulsions]. The procedure is carried out under
a general anaesthetic and the patient can expect quite
marked bruising and approximately ten days off work whilst
the surgical incisions heal and full recovery takes place.
A newer way of treating varicose veins is by minimally
invasive laser surgery if the patient is suitable. This
keyhole technique avoids a groin incision and stripping.
Following a venous duplex [ultrasound] to establish suitability
for endovenous laser ablation [EVLA], laser energy is
used to seal the vein from the inside, stopping the blood
from flowing in the wrong direction. Under local anaesthetic
a laser fibre is passed up the leg via a tiny needle puncture
at the level of the knee. The laser fibre is then positioned
in the superficial vein under ultrasound control. Following
activation of the fibre using laser energy it is then
slowly withdrawn and the vein is sealed. A compression
stocking is applied and the patient can be discharged.
The procedure, when carried out in isolation, can be done
under local anaesthetic. If avulsions are required in
addition, the procedure is done under a short general
anaesthetic. In either case the patient's recovery is
much quicker because there is no surgical incision in
the groin and therefore no scarring. There is also much
less pain and bruising with this procedure and the patient
is able to resume normal daily activities immediately.
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