In clinical trials, endovenous laser ablation for vein disease has proven to be safe and effective for truncal veins. More importantly, they have proven to be associated with better long term results, faster recovery and improved quality of life in comparison to older, outdated methods like surgical stripping. The modern day minimally invasive techniques for vein treatment have been revolutionary.
Equipment
The mostly commonly used device used by the vein specialists NJ is VenaCure EVLT by Angiodynamics. This EVLT system is based on delivery of infrared lasers that target hemoglobin.
Procedure
Laser ablation is minimally-invasive and can be performed directly in the office. Most vein specialists in NJ perform the procedure in a dedicated room that provides a sterile environment and houses the necessary equipment. In general, thermal ablation is utilized for truncal veins like the GSV and SSV or some of the tributaries.
Access for the ablation catheter is obtained by venupuncture under ultrasound guidance. Prior to access, the area of treatment should be sterilely prepped and draped per usual protocols. Lidocaine or similar local anesthetic is used to numb the region of interest. Using the modified Seldinger technique, the vein is prepared for treatment with exchange of wires for a percutaneous sheath. In the case of the GSV access can be obtained anywhere distal to the SFJ (or in the case of the SSV, distal to the SPJ) that provides adequate treatment of the culprit vein. The ablation catheter is then advanced into its target position under careful ultrasound guidance making sure that any positioning into deep venous structures is avoided. Before the heat sources is turned ON, the saphenous sheath in the region of interest is infused with diluted tumescence anesthetic (combinations of lidocaine, saline, bicarbonate, and epinephrine). Epinephrine is used sometimes opted for by the vein specialist in the solution to minimize the vein size when treatment is performed. Tumescence has three purposes: 1) anesthetic 2) collapse the targeted vein to the size of the catheter where treatment can be more effective against the venous walls, and 3) direct collateral tissue and nerves away from the targeted region to reduce risks of injury.
Once adequately anesthetized, the vein doctor will activate the generator to initiate thermal injury. The catheter will then be withdrawn 1cm/s until the catheter has fully treated the targeted segment and can be withdrawn in entirety from its insertion site. The sheath is also withdrawn and hemostasis at the access site is achieved by manual pressure. Post procedure after care instructions are then provided to the patient by the vein treatment clinic per usual protocol.
At minimum, the patient will return to his vein specialist with in 1 week to rule out any unintended complications, like DVT. Thereafter, each vein clinic follow their own protocol to assess the need for additional treatments based on any continued symptoms.
