How It Works

EVLT involves first using duplex ultrasound to map out the saphenous vein and then move a laser fiber through the vein to the groin. The laser emits highly targeted energy to seal the vein shut. With the closure of this vein, the branch veins of the saphenous vein (those veins close to the skin that become twisted and varicose) shrink and lose their unsightly appearance.

Unlike therapies such as sclerotherapy, ambulatory phlebectomy, and ligation and stripping, EVLT uses new technology to close the saphenous vein and address the main underlying source of the problem.

EVLT Step by Step

• After sterile prepping and draping of the leg, the ultrasound probe is placed into a sterile probe cover.

• With the patient in a head up position, under local anesthesia and using ultrasound guidance, percutaneous entry is made with a 7cm 19-gauge needle into the Greater Saphenous Vein, around the knee level. It is sometimes helpful to nick the skin at the puncture site to aid insertion.

• A 0.035" J-tip guide wire is inserted into the vein through the needle.

• Once in place the needle is removed and discarded and a 45cm 5 French introducer sheath is inserted over the guide wire.

• The sheath is advanced to at least the Sapheno-Femoral Junction.

• The internal dilator and guide wire are removed to allow aspirate blood into the syringe and then the sheath is flushed with normal saline.

• 810nm Laser safety glasses are issued and must be worn by the patient and all staff in the treatment room.

• Attach a sterile laser fiber (600µm EVLT Fiber with distance markings) to Diomed laser.

• The 600µm EVLT laser fiber is inserted into the sheath and advanced until the first (distal) marker on the fiber reaches the introducer opening. At this point the tip of the fiber will be coincident with the tip of the introducer sheath.

• The position of the introducer sheath and fiber within the GSV is checked using ultrasound. The sheath and fiber are positioned with their tip 1-2 centimeters below the Sapheno-Femoral Junction.

• The aiming beam is activated by placing the laser into the READY mode.

• Holding the fiber still the introducer sheath is withdrawn 3 centimeters until the second (proximal) marker on the fiber is coincident with the introducer opening. At this point distal portion of the laser fiber will be exposed from the end of the introducer sheath.

• Location of the fiber is reconfirmed using ultrasound guidance and by direct visualization of the red aiming beam of the laser fiber through the skin.

• The laser fiber should be secured to the introducer sheath with a locking mechanism attached to the distal end of the catheter to stop them from moving independently of each other during the procedure.

• Perivenous local anesthesia, 0.3% lidocaine, is administered along the Greater Saphenous Vein. (N.B.The choice of local anesthetic regime may vary from physician to physician)

• The patient is placed in a head down (Trendelenburg) position and a final check of the laser fiber tip position (about 1-2 centimeters below the Sapheno-Femoral Junction) is made using ultrasound.

• The laser power is set at 14 Watts in a continuous mode.

• Turn down lights and check position of fiber tip via aiming beam trans-illumination.

• As the laser is fired, the physician slowly withdraws the fiber at a rate of 1 millimeter per second for the first 10 centimeters, then 2 to 3 millimeters per second of laser energy delivery to the entry point. The procedure is considered complete when the desired length of the Greater Saphenous Vein is treated.

• The amount of energy used during the procedure can be calculated as 1400J for the first 10cm, plus the remaining length (mm) divided by pull back rate (average of 2.5mm/sec) then multiplied by 14 watts/second.


After the Procedure

• Following withdrawal of the fiber and sheath, the patient is dressed with a compression bandage that will be worn for up to three days, 24 hours per day. (The choice of dressings may vary from physician to physician). The patient takes a 20-minute walk immediately after the procedure and is then sent home.

• A Class II compression stocking is worn for 7 days following treatment.

• Normal activity can be resumed during this period, but hot baths and vigorous activity such as gym workouts should be avoided.

• Any post treatment discomfort can be treated with over-the-counter non-aspirin analgesics.