Details of Procedure
Endovenous Laser Treatments (ELT)
After diagnostic studies are performed the patient returns to the office for the outpatient ablation treatment. In the procedure room, the patient lies on a treatment table and is prepped and draped. Using ultrasound guidance along with a sterile ultrasound probe cover. The saphenous vein usually is visualized above the knee level. Next, using a 10 cc syringe and 25 gauge needle, approximately 5 cc of tumescent anesthetic is injected subcutaneously. With ultrasound in the grey scale, the saphenous vein is punctured percutaneously with a 21 gauge needle. A #5 French micro introducer guidewire then is threaded into the vein followed by the introducer. A 0.035 guide wire is passed with ultrasound guidance up to the saphenofemoral junction and a 5 french introducer is placed over the guidewire. A 600 micron laser filament then is placed into the introducer, and its placement at the saphenofemoral junction is verified by ultrasound.
The tissue surrounding the vein is infiltrated with tumescent anesthesia, numbing the area including the saphenous vein up to the groin using a pressure bag and long cannula., next the laser probe is place about 1-2 cm from the saphenofemoral junction and the sheath pulled back 2 cm from the tip of the laser probe, The sheath and laser probe are removed together at 1-2 mm increments using 12 watts for the first 20-30 firing then 15 watts for the remainder of the vein. A total of 100-200 firing are typical for this procedure.
Other Treatments Available
Following the procedure, multiple small stab wounds are created with an #11 blade over the marked varicose veins that meander off of the main vein. These remaining veins are grabbed using small hooks and clamps to avulse the vein. Other surface veins may need to be injected with sclerosing solutions, usually sodium dodecyl sulfate 0.2-1%. Other more superficial veins may be treated with the 940 nm laser.
Patients are discharged the same day, wear pressure dressing for the next 48-72 hours. Compliance with wearing the pressure dressing in the immediate post-operative period is critical to successful treatment. Compression stocking are worn during the daytime only for the next two to three weeks. Most patient return to work within a few days and depending on the type of work that they do may have limited duty for only a short time.