Varicose veins are a common manifestation of chronic venous insufficiency, where veins, usually in the legs, become enlarged and twisted. This occurs when one-way valves fail, allowing blood to flow backward and pool, increasing pressure and stretching the vein walls. Endovenous Laser Treatment (EVLT) is a leading minimally invasive approach that offers an alternative to traditional vein stripping surgery, providing effective treatment with a shorter recovery time.
Understanding Endovenous Laser Treatment
Endovenous Laser Treatment utilizes thermal energy, or heat, to close off the problematic vein from the inside. The procedure begins with the use of ultrasound imaging to map the diseased vein, typically the Great Saphenous Vein, and guide a thin fiber optic catheter into it. Once the catheter is positioned, a dilute local anesthetic solution is injected around the vein; this tumescent anesthesia protects surrounding tissues and compresses the vein against the laser fiber.
The laser is activated as the catheter is slowly withdrawn along the length of the vein. This delivers focused heat energy directly to the vein wall, causing the vessel to contract, collapse, and seal shut permanently. Closing the incompetent vein eliminates the source of abnormal blood flow. The body naturally reroutes the blood to healthier veins nearby, and the treated vessel is gradually absorbed over time. EVLT is performed on an outpatient basis, allowing patients to walk immediately after the procedure.
Measuring and Defining Treatment Success
Defining the success of Endovenous Laser Treatment involves a two-tiered approach: technical success and clinical success. Technical success refers to the immediate and sustained physical closure of the treated vein, confirmed using follow-up ultrasound scans. The technical success rate—the vein remaining closed—is often cited between 95% and 98% in the first year following the procedure.
Clinical success includes the relief of symptoms, such as pain, aching, and heaviness, and improvement in the vein’s appearance. Long-term studies evaluating sustained closure and clinical improvement over three to five years generally report success rates ranging from 80% to 96%. Follow-up ultrasound evaluations are routinely performed to ensure the treated vein remains sealed and to monitor for any new areas of reflux.
A small percentage of patients may experience persistent symptoms even after successful technical closure, sometimes due to the progression of underlying venous disease or issues in other veins. When measured at the five-year mark, the rate of anatomic closure—the treated vein remaining completely shut—is typically found to be in the range of 77% to 85%. This difference from the initial closure rate accounts for instances of partial recanalization, where a segment of the vein reopens.
Factors Influencing Long-Term Outcomes
Several variables influence the long-term effectiveness of EVLT, including patient-specific characteristics and technical elements. The diameter of the vein is a physical factor, as larger veins may require more delivered laser energy for sustained closure. The patient’s overall health, including body mass index and the presence of severe underlying deep vein insufficiency, can also influence outcomes.
The technical execution of the procedure is important, particularly the amount of energy applied to the vein wall. Delivering adequate linear endovenous energy density is necessary for achieving an irreversible thermal effect. Insufficient energy delivery, especially in larger or more twisted veins, has been linked to a higher chance of the vein reopening over time. Adherence to post-procedure instructions, such as regular walking and consistent wearing of compression stockings, is also important for promoting healing and long-term success.
Managing Vein Recurrence
Managing the long-term issue of varicose veins returning requires a distinction between treatment failure and true recurrence. Treatment failure means the originally treated vein reopens (recanalization) or was never fully closed. True recurrence refers to the development of new varicose veins in a different location due to the progressive nature of chronic venous disease.
Chronic venous insufficiency is a lifelong condition, and a successful EVLT procedure does not eliminate the tendency to form new varicose veins. The development of new veins, often arising from untreated tributaries or perforator veins, occurs in approximately 10% to 20% of patients within five years. These new veins usually require secondary treatments, such as injection sclerotherapy or microphlebectomy, to maintain clinical benefits. While recurrence can be frustrating, it is generally manageable with less invasive follow-up interventions.