The vein that is treated by EVLT remains closed for the rest of your life, and as time passes, it gets absorbed to a certain extent by the body. Sometimes, an ultrasound performed months or years later can see the vein remain closed as a “cord” without a lumen. Other times, the ultrasound cannot even locate the closed off veins.
The fact of the matter is that there are already “other veins” that are currently directing the blood flow back to the heart, because the refluxing veins are currently sending the venous blood back down the leg (when standing or sitting for long time). When the abnormal vein is shut off, these other veins will have an “easier time” carrying the blood out of the leg.
An important innovation about the EVLT is that it can be performed with the patient wide awake. It only requires local anesthesia, i.e. injections with lidocaine-containing solution. You will be given “sedative pills” such as Lorazepam the night before and 2 hours before the procedure, but for most patients, even these are not necessary. You will also be prescribed an anesthetic “cream” as a way of making the skin sensitivity “dull” to minimize the discomfort associated with needle injections. But then again, for many patients, even this is not necessary. General anesthesia is a potentially dangerous undertaking for patients, and it is completely unnecessary for this procedure. In fact, in Advanced Vein Care Center, we have performed thousands EVLT’s in the past several years. We have never had to use anything more than local anesthesia to perform those procedures, even in the most anxious patients prone to panic attacks.
We do all our EVLT procedures in one-hour sessions. We have learned from performing over 3,000 procedures that one hour is the optimal time for completing the procedure. Beyond one hour, there arises a greater chance of issues arising from patient’s back pain, hip pain, bladder incontinence, fatigue, etc. If you have very complex venous reflux anatomy where there are more than 2-3 veins that need to be treated, you may require two EVLT sessions.
For the same reason as above, we treat one leg at a time, one week apart. Treating both legs in the same setting takes too much time and discomfort during the procedure. There are tissue trauma, post procedural pain and discomfort that follow each EVLT procedure, such that treating both legs simultaneously can be overwhelming for most patients.
There can be mild to moderate pain associated with post-procedural inflammation. We use a low-frequency laser technology to minimize post-procedural pain. Usually most patients tolerate pain with anti-inflammatory analgesics such as Ibuprofen alone. We seldom have patients who require re-fill of these pain medications.
The veins that we treat with EVLT will stay closed with a success rate of 95 to 98 %, long-term. If your leg pain and discomfort are caused by venous insufficiency, then EVLT will result in significant improvement in pain and discomfort patients. If your concern is that of leg swelling, the following is what we have observed. After EVLT, the pain and discomfort and the “pressure” associated with your swelling in the leg will improve. But the “disappearance” of swelling will depend on the nature of your swelling, such as the cause of your leg swelling above and beyond the refluxing veins (such as obesity, heart/liver/kidney conditions, etc.), the duration of your leg swelling, etc. In some patients, the appearance of swelling does not return to normal even though the pain and discomfort is alleviated.
No. Only those patients who have bumpy veins that ‘stick out’ on the skin require phlebectomy.
Phlebectomy requires total focus and concentration on the part of the surgeon while utilizing fine-tip instruments through the micropuncture skin opening. Usually only 10 to 20 vein segments can be removed at a time, in one-hour sessions. Some patients have a “plethora of veins” on their leg requiring more than one session. This will be determined during your office visit when you get to tell Dr. Lee the extent to which you want your veins removed, and that will determine the treatment sessions it will take to remove your veins.
Usually we try to schedule phlebectomy within days after EVLT, so that everything on your leg is completed within a week if possible, even if more than one phlebectomy session is required.
Before the removal of veins starts, the skin and the subcutaneous tissue over the vein will be anesthetized with a local anesthetic infusion. This part will cause transient, mild pain as all local anesthetic injections do. But this will render the skin and the vein painless during the rest of the procedure. So, the removal of the vein itself does not hurt.
For almost all patients, phlebectomy is performed within days after EVLT, and the answer to this question is the same as that given for EVLT procedure (see the Q&A on this topoic in EVLT section). Generally speaking, the day after phlebectomy, most patients can return to work, even to a moderately strenuous activity, wearing compression stockings.
Since 2013, we’ve been making one leg at a time beautiful. Healthy legs are the key to a healthy lifestyle
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