Endovenous laser ablation
The Center for Minimally Invasive Surgery at St. Catherine Specialty Hospital uses the most advanced method of minimally invasive treatment for varicose veins. Postoperative recovery is significantly less painful compared to traditional surgery, with a faster return to daily activities.
What causes varicose veins?
The cause of varicose veins (varicosities) is so-called venous insufficiency.
Blood flows through veins from the periphery toward the heart via two venous systems:
- the deep system, located within the muscles
- the superficial system, located just under the skin
Inside the veins are valves that function as one-way gates, allowing blood to flow only toward the heart. The valve opens to let blood pass and then closes to prevent it from flowing back into the legs. If the valves are damaged or do not function properly, venous insufficiency develops.
The largest superficial vein (great saphenous vein) drains into a deep vein in the groin area. A valve is also located at this junction; if it does not function properly, blood accumulates in the great saphenous vein and its branches beneath the skin, causing them to become enlarged and tortuous.
Factors contributing to varicose veins: obesity, older age, female sex, physical inactivity, leg injury, pregnancy, smoking, use of oral contraceptives or hormone replacement therapy, family predisposition.
In addition to being visible, varicose veins can cause various symptoms:
- dull pain, burning, or heaviness in the legs (often worse in the evening or after prolonged sitting/standing)
- leg swelling (especially in the feet and ankles)
- itching in the affected area
- skin discoloration (stasis dermatitis) and skin changes (dryness, tightness)
- superficial thrombophlebitis (clot and inflammation in a small superficial vein)
- open wounds (ulcers)
- bleeding after minor injury
Candidates for laser treatment
- Insufficiency of the great saphenous vein
- Insufficiency of the small saphenous vein
Description of the laser procedure
A laser is a highly focused beam of light that generates heat to damage the vein, creating scar tissue. This scar tissue closes the vein. Once closed, the vein loses its blood supply and gradually disappears, while blood is redirected through nearby healthy veins.
Varicose veins located directly under the skin cannot be treated with laser alone; they are additionally managed with microphlebectomy (surgical removal) or foam sclerotherapy.
Preoperative preparation
A Doppler ultrasound examination is required to determine whether venous insufficiency is present and which vein is affected. Based on this and a vascular surgeon’s assessment, the most appropriate treatment method is chosen.
Depending on the treatment plan and the patient’s overall health, additional diagnostic or laboratory tests may be required.
No special preparation is needed, except fasting (no food or drink) for 6 hours before the procedure.
Procedure
Before the procedure, an IV line is placed, and the patient receives a sedative and analgesic. The procedure is performed under local anesthesia.
After a small skin incision, a laser fiber is inserted and positioned inside the vein under ultrasound guidance. Local anesthetic is also injected around the vein. The laser fiber is then gradually withdrawn while emitting energy to close the vein. This is usually followed immediately by microphlebectomy or foam sclerotherapy. The procedure typically lasts about one hour. At the end, the patient is fitted with an elastic compression stocking.
Recovery after the procedure
Patients can walk immediately after the procedure - walking is actually encouraged.
For the first 3 days: avoid strenuous physical activity (running, cycling, gym)
Mild tightness, discomfort along the inner thigh, and minor bruising may occur
From day 4: compression stockings are worn during the day only, and normal physical activity can gradually resume
From day 7: full return to normal physical activity is allowed
Precautions
As with all venous procedures, possible complications include deep vein thrombosis (DVT).
