Checkup

Surgeons Use New Laser Treatment
on Varicose Veins

Minimally Invasive Procedure is an Alternative to Surgery

Dr. Albert Hakaim talks with patient Lois Quinby the day before her EVLT surgery. Quinby experienced two painful ruptures in a varicose vein, which made her a candidate for the new procedure.

Vascular surgeons at Mayo Clinic are performing a new, minimally invasive procedure called endovenous laser treatment (EVLT) to treat varicose veins. EVLT is an alternative to both traditional surgery and other minimally invasive treatments.

Patients are given a regional anesthetic before the surgeon inserts a needle into the greater saphenous vein near the knee. The greater saphenous vein runs from the ankle to the groin. Numerous superficial veins branch off this vein, and venous reflux in the greater saphenous vein is usually the root problem underlying varicose veins. With ultrasound guidance, the surgeon inserts a guide wire through the needle and advances it through the vein to the groin. This allows placement of a catheter and the special laser into the vein. The surgeon turns on the laser and slowly removes the laser fiber, which collapses the vein as it is retracted.

"The laser vaporizes the blood and collapses the inner vein wall so that blood can no longer flow through the vein," says Dr. Albert Hakaim, who performs EVLT. "The laser fiber does not have to be in contact with the vein wall, so there's no limitation on the width of the vein that can be treated."

A comparable procedure, which uses radiofrequency energy to collapse the vein, can only be used on veins up to 12 millimeters in diameter. Hakaim says other advantages of EVLT include shorter recovery time than traditional vein stripping or ligation surgery, no scarring and a quick return to normal activities.

EVLT takes less than an hour to perform. Patients are observed for six hours before going home to resume normal, but not vigorous, activities. They wear a small bandage over the treated site and an elastic wrap for seven days. Most patients experience immediate relief from their symptoms, and published data reports a 98-percent success rate.

About 15 percent of adults in the United States, most of them women, have varicose veins. Heredity, age and pregnancy increase a person's chance of developing venous reflux, the condition that causes varicose veins. Obesity, physical trauma to the legs and standing for long periods of time can aggravate the condition. Venous reflux occurs when tiny valves within a vein become damaged, allowing blood to flow backward and build up inside the vein. This causes further damage to downstream valves, and the condition worsens.

Info:
Division of Vascular Surgery
(904) 953-2077

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