Endovenous laser treatment or EVLT is a minimally invasive treatment method using the latest generation of laser equipment with a wavelength of 1470 nm and has an absolute preference for varicose vein operations in recent years.
Varicose veins
and treatments
Varicose veins or varices are enlarged and winding veins. The term varicose vein (-disease) usually refers to the veins in the lower limbs, but can also, albeit much less frequently, occur in other places. Inside each vein, one-way valves prevent the blood, which has arrived in the leg through the arteries and must return to the heart through the vein, from flowing back down under the influence of gravity. When these valves no longer work as they should, the arterial wall weakens and expands. The good news is that almost always only the superficial vein system is affected by this varicose vein- disease, accounting for about 10% of the back flow of the blood. The rest of the back flow of the blood returns to the main arteries inside the limb.
If these superficial veins do not work properly, they can be removed or closed without serious damage (see below). It is very important to have an annual check-up after varicose vein treatment: family predisposition or hereditary predisposition is the main reason for your problem. In case you develop a new varicose vein somewhere, this will certainly be detected during an annual check-up, and there are other methods than the surgical one to treat a new varicose vein at this initial stage. This is almost always possible on an out-patient basis at the consultation.
Where can varicose veins occur?
Varicose veins are most common in the superficial veins of the lower limbs (vena saphena magna, vena saphena parva), which come under high pressure when we stand up. They can also, but much less frequently, occur in other places, such as chest, arms, face (rosacea).
Externally this presents itself as a winding, bumpy line at the skin level.
Smaller veins can also become varicose, which is referred to as reticular varices (spiders, jumping veins) which we see as aesthetically bothersome pink to blue branched lines on the leg. Larger and smaller varicose veins often occur together but can exist separately.
Symptoms
In addition to aesthetic problems, varicose veins can also be painful, especially when standing or walking for long periods of time. They can be the cause of fluid accumulation at the ankles, lower legs and feet (oedema), nocturnal muscle cramps, restless legs. Varicose veins can already be present with symptoms at an early stage, before externally important abnormalities can be observed with the eye. Varicose veins rarely give rise to serious complications, although a complication is still often the first symptom of varicose vein disease today, which brings the patient to the doctor.
Untended varicose veins can lead to thrombosis, phlebitis, pulmonary embolism, open leg injuries. If you have doubts about the proper functioning of your veins, a clinical and colour duplex examination can help to clarify this.
Diagnosis
Very often the diagnosis can already be made through clinical examination. With a treatment, it is important to know where a varicose vein begins, usually at the groin fold or knee fold, or sometimes in other places. For varicose vein treatment to be successful, a colour duplex examination (ultrasound, completely painless examination) of the main veins and superficial veins is performed in addition to the clinical examination. Because of this we can perfectly determine where the varicose vein has its origin. After a few measurements, we immediately know what the treatment options are.
Remove varicose veins
Non-operative treatments
Complaints caused by problems with the main arteries inside the limb can often be resolved in a non-surgical way. Your specialist will advise you to wear certain compression stockings, take medication to strengthen the arteries and sometimes physiotherapy is suggested.
The complaints caused by poorly functioning superficial veins can also be improved by these treatments but of course the varicose vein problem itself is not solved. This treatment method is an option for patients who for some reason can no longer be treated surgically for varicose vein disease (too old, heavy blood thinning medication…).
Spiders
Spiders or “broken capillaries” are common on the legs, cheeks and nose. They are red, blue or purple. Normally these blood vessels are invisible, but with some people they expand and become visible through the skin. There are several causes: exposure to the sun, pregnancy, hormonal treatment and especially heredity. During the menopause, the skin becomes thinner and loses some of its collagen, making the small veins more visible.
For facial spider veins (couperose, rosacea), laser is the best treatment. For spider veins on the legs, sclerotherapy was previously used. Now, this is treated exclusively with laser.
Slide the bar to see the effect of the treatment.
Surgical treatments
When a superficial vein becomes varicose from the groin or knee fold onwards, or from a perforator vein (vena perforans) to the main vein, this usually has to be treated surgically.
In case of a thicker local varicose vein, a local removal of the diseased piece of vein is often suggested. Under local anaesthesia a mini incision of 1.5 to 2mm is made and the diseased vein is removed. Post-treatment is the wearing of a compression stocking.
Stripping used to be the gold standard for varicose vein treatment. This technique has been abandoned due to its invasive nature or is only performed when there is a strict medical contra-indication for endolaser treatment or radio frequency treatment.
Aftercare
A crucial part of aftercare following varicose vein treatment is an annual checkup: varicose vein disease is a chronic disease with a hereditary predisposition.
If you develop a new varicose vein, this will definitely be detected during an annual checkup, and there are other methods besides surgery to treat a new varicose vein in this early stage. This can almost always be treated during an outpatient consultation.