What is EVLA?

Most varicose veins are fed by a larger vein beneath the skin in which the valves have stopped working, allowing blood to flow backwards and pool in the leg. EVLA treats this underlying vein. A fine laser fibre is passed inside the vein and used to heat its wall, causing the vein to close. Blood naturally reroutes through healthy veins, and the treated vein is gradually absorbed by the body.

Because the vein is treated from the inside, there are no large incisions, no stitches and no need for a general anaesthetic.

Who is suitable?

EVLA is suitable for most patients whose ultrasound scan shows faulty valves in one of the main superficial veins of the leg. It may be recommended if you have:

  • Symptomatic varicose veins causing aching, heaviness or swelling.
  • Skin changes around the ankle, such as discolouration or eczema.
  • A history of phlebitis, bleeding from a varicose vein, or a leg ulcer.
  • Varicose veins that have returned following previous surgery.

Your consultant will confirm whether EVLA is right for you following your scan. It is not usually carried out during pregnancy.

At a glance

Procedure time: 30 to 60 minutes per leg. Anaesthetic: Local. Hospital stay: Day case, walk in and walk out. Time off work: 1 to 3 days for most patients. Compression stockings: As advised by your consultant. Exercise: Walking from day one, strenuous exercise after 1 to 2 weeks.

How does EVLA work?

The vein is located and marked using ultrasound.

A small amount of local anaesthetic is used to numb the skin, usually near the knee or calf, and a fine laser fibre is passed into the vein through a tiny puncture.

Local anaesthetic fluid is placed around the length of the vein. This numbs the area and protects the surrounding tissue.

The laser is switched on and the fibre is slowly withdrawn, sealing the vein as it goes.

A small dressing and a compression stocking are applied, and you are able to walk straight away.

If you also have visible varicose veins on the surface, these are often treated at the same visit with phlebectomy or foam sclerotherapy.

Aftercare and recovery

You will be encouraged to walk immediately after your procedure and to keep active in the days that follow. You will be asked to wear a compression stocking on the treated leg, and your consultant will advise how long this is needed.

Some bruising, tightness or a pulling sensation along the inner thigh or calf is normal, often most noticeable around a week after treatment, and usually settles within a few weeks. Over-the-counter pain relief is generally sufficient. We recommend arranging for someone to take you home, and speaking to your consultant before any long-haul travel in the weeks following treatment.

Risks

EVLA is a safe procedure and serious complications are uncommon. Risks include bruising, tenderness or tightness along the treated vein, inflammation of the vein (phlebitis), small areas of numbness caused by irritation of a nearby skin nerve, brown discolouration of the skin, and, rarely, infection or a skin burn. Uncommonly, a blood clot can form in the deep veins of the leg (deep vein thrombosis). Your consultant will discuss all risks with you at consultation.

Frequently asked questions

Is EVLA painful?

You will feel the local anaesthetic injections, which can sting briefly. Once the area is numb, the laser treatment itself is generally well tolerated. Mild aching or tightness in the days afterwards is common.

How successful is EVLA?

EVLA is a well-established treatment with high success rates, and the treated vein remains closed in the large majority of patients. Your consultant will check the result with an ultrasound scan at follow-up where required.

How is EVLA different from vein stripping?

Vein stripping physically removes the vein through incisions in the groin and leg, usually under general anaesthetic. EVLA closes the vein from the inside through a pinhole, under local anaesthetic, with less bruising and a quicker return to normal activity.

Will EVLA remove the veins I can see?

EVLA treats the underlying vein that is causing the problem. Visible veins often shrink afterwards, but most patients also have phlebectomy or foam sclerotherapy to treat them directly.

Can both legs be treated at the same time?

In many cases, yes. Your consultant will advise whether it is appropriate to treat both legs in one visit or on separate days.

When can I return to work and exercise?

Most patients return to work and normal daily activities within one to three days. Walking is encouraged straight away. Strenuous exercise, heavy lifting and swimming are usually avoided for one to two weeks.

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