Endovenous Laser Therapy (EVLT) | Doctors & Treatment Information

Endovenous laser therapy (EVLT or endovenous laser ablation (EVLA)) is a minimally invasive procedure used to treat varicose veins.

Minimally invasive means that the procedure causes as little disruption to the body as possible through surgical incisions.

EVLT is an alternative to surgical treatment of varicose veins. With EVLT, the veins are removed without surgery.

Instead, the doctor uses a laser to seal off the dilated vein (varicose vein) from the inside.

To put it another way: In surgical procedures, doctors remove the vein through skin incisions.

With endovenous laser therapy, the vein is sealed from the inside. It does not need to be removed.

Both procedures aim to prevent discomfort that occurs when standing or sitting.

Endovenous laser therapy (EVLT) is a minimally invasive alternative to conventional treatments for varicose veins @ Svitlana /AdobeStock

As explained above, endovenous laser therapy is used to treat varicose veins. This is a very common condition.

In Germany alone, 20 to 25 percent of women and 10 to 15 percent of men suffer from this venous condition. There are also varicose veins that are not visible. Experts therefore estimate that the actual number is even higher.

Varicose veins are therefore a “common condition.” For this reason, there are several options and procedures available to treat this harmless but chronic and progressive condition. Chronic and progressive means that it worsens over time and does not resolve on its own.

In the past, it was common to treat varicose veins surgically. The stripping method was considered the gold standard.

In this procedure, the doctor makes a 3- to 4-centimeter-long incision in the groin area. He then inserts a metal probe, guiding it downward through the varicose vein toward the foot. Through an additional incision, he removes the varicose vein at its lowest point, where the vein is dilated.

Since 1998, it has been possible to treat varicose veins from the inside (endovenously). The goal is to seal and close off the varicose vein.

When heat is used during treatment (as with laser or radiofrequency therapy), this is referred to as a thermal procedure.

If doctors use a liquid or foam-based sclerosing agent (usually containing alcohol) that they inject into the vein, this is referred to as chemical endovenous therapy. An incision in the groin is not required for endovenous procedures.

The principle of foam sclerotherapy is to chemically irritate the vein walls and thereby seal off the abnormally dilated blood vessel @ Solarisys /AdobeStock

Several European and American studies have demonstrated the positive effects of EVLT. After three years, only 3 percent of all patients experience a reopening of the vein.

As a result, the success rate of EVLA even exceeds that of the stripping method. Furthermore, varicose veins that recur after a stripping procedure or mild varicose veins can be successfully treated with a laser.

EVLT should be used with extreme caution in very thin patients with little subcutaneous fat. Otherwise, the laser heat can cause skin burns. Temperatures can reach over 100 degrees Celsius near the tip of the catheter.

For this reason, during laser therapy, doctors inject a fluid next to the vein to cool the tissue and skin. This allows them to minimize the risk of burns as much as possible. This special fluid (tumescent solution) also contains a local anesthetic, which helps alleviate postoperative pain.

Stripping surgery is the classic varicose vein procedure, in which doctors make an incision in the groin or the back of the knee and remove the varicose vein @ eliosdnepr /AdobeStock

Endovenous laser therapy is usually performed under local anesthesia.

First, the doctor injects the tumescent solution into the tissue. Then, he punctures the varicose vein just below the knee joint with a needle. If the vein is superficial and visible, this can be done with the naked eye; otherwise, he uses ultrasound.

Next, the doctor advances the probe of the laser device upward through the varicose vein until it reaches just below the groin. He monitors the position of the probe tip using ultrasound.

He then slowly and gradually moves the probe tip downward from top to bottom. Since the probe glows at the tip, it is visible through the skin. As the probe is withdrawn, the laser probe emits repeated pulses to coagulate the vein from the inside.

The treatment takes about 30–45 minutes and is performed on an outpatient basis. Immediately after the treatment, the patient is fitted with a special compression bandage.

This helps the vein wall to adhere and reduces pain symptoms. For this reason, wearing compression stockings for 14 days is recommended.

Endovenous laser therapy offers patients several advantages:

• EVLT is a minimally invasive procedure that is virtually painless. The patient does not need to remain on bed rest.
• Unlike vein stripping surgery, the recovery period is significantly shorter, so time off work is limited to just a few days.
• Because there is no surgical incision, the patient does not experience postoperative pain or bruising.
• Patients can resume physical activities as early as two weeks after the procedure.
• Furthermore, the cosmetic outcome after EVLT is usually better than after stripping.

One disadvantage is that venous inflammation or venous thrombosis, as well as perforation of the vein wall, can occur more frequently after EVLA. 

This method is not suitable for:

• Marked tortuosity of the vein
• Superficial location and 
• Varicose veins on the lower leg

The risk of complications with endovenous laser therapy is considered low.

In some cases, the following may occur:

• Sensory disturbances
• Skin discoloration
• Venous thrombosis or
• Bruising

In addition, more severe pain in the area of the occluded vein is possible.