Laser vein sealing

Endovenous lasers in contemporary phlebology

The development of laser techniques in the treatment of lower limb venous insufficiency has been gradual, with certain breakthrough moments. The first endovenous (or endoluminal or endovascular) lasers were used between 2000 and 2008. Their systems operated at wavelengths of 810, 940, and 980 nm. In these systems, the damaging role was mainly played by the absorption of light in the hemoglobin contained in red blood cells. Although they were effective, their use was associated with a much higher risk of complications and postoperative discomfort. A real breakthrough in endoluminal laser techniques occurred in 2008 with the introduction of lasers with a wavelength of 1470 nm, whose action is mainly based on absorption in the water contained within the vein wall. This change, combined with the introduction of radial (ring) and later dual-ring optical fibers, significantly increased the safety and comfort of endovenous procedures. In 2019, the 1940 nm laser was introduced, opening a new chapter in the development of this technology.

Endovenous Laser Ablation System (ELVeS)

ELVeS Laser System - utilizing dual-ring optical fibers (Radial 2ring) from Biolitec represents the most advanced technology in endovenous laser therapy.

Contemporary EVLA procedures utilize advanced laser technologies and specially designed optical fibers. These enable safe and effective treatment of incompetent venous vessels. At the Phlebology Clinic, we most commonly use the ELVeS 1470 nm laser system with 2-ring fibers. Based on current observations and clinical studies, the best therapeutic effects are achieved with the 1470 nm wavelength laser. While the 1940 nm wavelength allows for safer closure of vessels located superficially under the skin, it yields poorer treatment results due to its 5 times greater absorption in water compared to the 1470 nm laser. Its action is much shallower within the vein wall itself, leading to worse outcomes in the treatment of larger venous vessels.

ELVeS Laser System utilizing dual-ring optical fibers (Radial 2ring) has many advantages. Below are some of the most significant.

Advantages of laser vein ablation with the ELVeS system

• post-operative effectiveness reaches 96% in observations over 5 years;
• the system enables effective closure of large veins with a diameter of over 10 mm;
• the innovative design of the 2ring optical fiber (laser light energy is distributed across two emission rings spaced 6 mm apart) causes initial shrinkage and then its complete closure by the beam originating from the second ring;
• minimal risk of vessel wall damage due to even energy distribution;
• virtually zero risk of damage to surrounding tissues and nerves with proper technique tumescent anesthesia;
• the procedure is virtually painless thanks to precise tumescent anesthesia;
• minimal risk of carbonization of the optical fiber tip;
• thanks to the fibers Radial 2ring slim (exceptionally thin and mobile) treatment of narrow and tortuous veins has become even simpler.

What can be treated using an endovenous laser?

Endovenous laser therapy is primarily used to treat incompetent venous trunks, such as the great saphenous vein, the accessory saphenous vein, and the small saphenous vein, as well as their main branches. This method can also be used to close incompetent perforating veins (tzw. perforatorów).

Typical indications for performing an endovenous laser procedure include:

• incompetence of venous trunks (e.g., the great and small saphenous veins);
• varicose veins of the lower limbs;
• recurrent venous disease causing the formation of recurrent varicose veins;
• venous insufficiency in advanced stages of the disease (C4-C6 according to CEAP);  
• incompetent perforators of the limbs, groin, and pelvic floor;

• cases after superficial thrombophlebitis;
• limb venous insufficiency in young individuals (most often due to pelvic venous insufficiency).

We most often use endovenous laser therapy as part of hybrid procedures (combined with other techniques), rarely as a standalone method. It is currently an element of the comprehensive treatment of chronic venous insufficiency. It works perfectly in combination with foam sclerotherapy for smaller subcutaneous varicose veins.

Price range

Description of the laser vein closure procedure

The endovenous laser ablation (EVLA) procedure begins with a gentle puncture of the access vein under the guidance of an ultrasound probe and the introduction of a thin optical fiber into its interior. This fiber emits a beam of infrared radiation with a specific wavelength and energy. The puncture is performed under local anesthesia using either a needle or a needle-free system, depending on the situation. Before activation, the optical fiber is guided under ultrasound control to the target location where the procedure will begin. Before this happens, the operator performs the so-called tumescent infiltrative anesthesia.

A specially chilled and prepared fluid containing the anesthetic agent is administered around the vein under ultrasound guidance. Tumescent anesthesia provides complete anesthesia of the treated area, as well as significant constriction of the venous vessel and its separation from surrounding tissues, nerves, or arteries.

After thorough anesthesia is administered, the procedure to close the incompetent vein begins. The energy delivered by the optical fiber heats the vessel wall, causing it to contract and close. The entire EVLA procedure is monitored using ultrasound equipment, which ensures exceptional precision while preserving the function of the remaining veins.

After the laser closure procedure for veins and varicose veins, a compression dressing and a class II compression stocking (CCL2) are applied. Thanks to the local anesthesia, the patient can walk and return to daily activities immediately after the procedure.

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Tumescent anesthesia and laser vein closure

This method is based on the administration of a specially prepared anesthetic solution (the so-called Klein's solution) – containing a diluted anesthetic agent, an admixture of adrenaline (epinephrine), and bicarbonate dissolved in a physiological saline solution) into the space around the vein or varicose vein being closed. The administration of the solution takes place under the control of ultrasound equipment, which ensures the precision and safety of the procedure. The standard volume of Klein's solution used during an endovenous procedure ranges from 350 to 800 ml. Tumescent anesthesia has a fairly strong effect for about 2-4 hours, and its post-procedure effect (reducing tissue pain) lasts for up to 24 hours after the procedure.

Tumescent anesthesia used during endovenous thermal procedures has many advantages. The most important of these are:

• ensuring complete anesthesia in the area undergoing the procedure;
• creating a protective layer of fluid around the vein being closed, which protects the surrounding tissues from the thermal energy of the laser;
• significant constriction of the venous vessel, which increases the effectiveness of the laser ablation procedure (especially in the case of very large veins);
• significantly fewer post-operative hematomas;
• the ability to mobilize the patient immediately after the vein procedure.

Tumescent anesthesia is currently the most modern and safest method of anesthesia in phlebological procedures. Thanks to its numerous advantages and high safety profile, it is an integral part of modern vein disease treatment.

Post-ELVeS procedure management

After the end of the laser procedure, a compression stocking (CCL2) is applied to the treated limb. Immediately after putting on the stocking and a short rest, the patient is asked to take an intensive walk lasting about 30 minutes. This walk is crucial for activating the calf muscle pump.

The compression stocking should be worn according to individual medical recommendations – in the first 24 hours after the procedure, it is usually left on continuously, including during sleep. For the following days after the procedure, the compression stocking is worn by the patient only during daily activity (for up to 10-14 days after the procedure). In the first few days, it is recommended to put on the stocking in the morning, before getting out of bed, when the leg is not yet swollen.

In the post-operative period, proper skin care and the use of preparations recommended by the treating physician are particularly important: anti-inflammatory and anticoagulant gels. These preparations should be applied to the skin by gently massaging them in, preferably in the morning and evening after washing the leg.

For 7-10 days after the procedure at Phlebology Clinic, we recommend taking low molecular weight heparin in pre-filled syringes as prophylaxis against early (post-operative) venous thrombosis. The injections are administered subcutaneously, at a fixed time of day, according to the detailed instructions of the treating physician. Immediately after the procedure, the patient receives detailed instructions from our nursing staff regarding the injection technique.

In the post-operative period, the use of" is also crucial late prophylaxis through regular but light physical activity. Walks and various exercises that moderately activate the calf muscles are particularly recommended.

The first post-operative follow-up visit, which takes place 3 to 8 weeks later and is combined with a follow-up examination. Doppler ultrasound of the veins. Based on this examination, the effectiveness of the treatment is assessed and further management is planned, including any additional procedures, if necessary. During this visit, the physician also evaluates the healing process and any symptoms reported by the patient. In some cases, a complementary or aesthetic procedure (such as microsclerotherapy) may be performed during the same visit to optimize the cosmetic outcome.

Contraindications for endovenous laser ablation

Here is a list of the most common contraindications for endovenous laser ablation procedures:

• active deep vein thrombosis (DVT);
• lack of cooperation from the patient.
• allergy to anesthetic and disinfectant agents;
• significant coagulation disorders;
• severe general condition of the patient;
• significant limitations in walking (disability);
• inability to use compression garments in the post-operative period;
• advanced atherosclerosis of the lower limb arteries;
• pregnancy;
• large post-thrombotic changes in the superficial and deep venous system.

Complications of endovenous laser ablation

No medical procedure is entirely without the risk of adverse events or complications. Despite exercising the utmost care, such events can rarely occur during or after the procedure. EVLA, like any medical procedure, carries a certain risk of complications, although they are rare.

The most common complications after EVLA include:

• reaction to anesthesia (transient swelling, bruising, anxiety, palpitations, allergic reactions);
• inflammatory reaction or thickening (induration) along the course of the ablated vein (may persist for several weeks after the procedure);
• subcutaneous hematomas (especially in patients using anticoagulant medications);
• chronic pain or sensory disturbances in the treated limb (usually resolve spontaneously after a few weeks);
• deep vein thrombosis (a very rare complication; great caution must be exercised in patients with thrombophilia!)
• wound infection (a very rare complication).

At the Phlebology Clinic we make every effort to minimise the risk of complications and our specialists remain available to patients during the recovery period. If you experience any worrying symptoms, please contact our Registry immediately.