Endolaser Vein System (ELVeS) for the treatment of varicose
veins at The London Clinic
Varicose Veins
Varicose veins affect up to 30% of the women
and 20% of the men in the UK, that is, approximately 3 million
people. Genetic predisposition, the female hormonal cycle and
hydrostatic pressure in late pregnancy are the predominant,
recognised, causative factors.
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Varicose veins are caused by valve
incompetence of the saphenous vein draining system of the skin of
the legs. As a result there is pooling of blood in the long
veins and swelling of the distal tributary veins which become
visible as bulging varicosities and cause symptoms of heaviness,
pain, itching and generalised oedema. The impaired venous
return is detrimental to the skin of the calves and ankles
resulting in hair loss, discolouration, eczema and ultimately,
ulceration.
Early treatment, before these secondary
consequences have become established, achieves the best
results.
Assessment
Choosing the optimum treatment regimen depends
on accurate assessment of the pattern of venous incompetence. At
consultation, a full history and examination is undertaken.
Venous duplex ultrasound is essential to elucidate the pathways of
venous incompetence and discover complicating factors such as dual
veins, aberrant connections, pudendal veins and the results of
previous surgery.
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Duplex ultrasound to assess veins
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Treatment of varicose veins
1. Surgery
Conventional treatment involves stripping of
the veins by surgery under general anaesthetic. This may be carried
out on a day-case basis, or more commonly with an overnight stay,
with the patient returning to full normal activities 3-6 weeks
later.
Stripping carries the risk of numbness of the
thigh due to skin nerve damage in up to 11% and a recurrence rate
of up to 10% at 1 year rising to 20 % at 5 years
Bruising and discomfort commonly may persist
for 3-6 weeks following surgery.
2. Sclerotherapy
Outpatient injection of sclerosant solution
(Sclerotherapy) is commonly used after laser treatment of
the main incompetent veins (or surgery where it replaces
phlebectomy) to complete the treatment of the smaller varicose and
spider veins.
3. Laser ablation treatment for
varicose veins (ELVeS/EVLT)
With an estimated 50,000 cases of varicose
veins treated every year in the UK but an estimated prevalence of
250,000 symptomatic cases, it appears that many people are not
coming forward for treatment. In particular the prospect of up to 6
weeks off work following surgery is off-putting for many working
people. However, Laser Treatment is now available allowing return
to normal activities within 24 hrs with results as good as, and in
some respects better than, surgery.
The EndoLaser Vein System (ELVeS) was FDA-approved in 2002 and
is CE-marked but it is new to the UK. See the recommendations of
the NICE guidelines of March 2004 www.nice.org.uk/pdf/IPG052guidance.pdf
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Endovascular laser techniques have been
developed that remove the need for stripping out the saphenous vein
by cauterising the vein in-situ, resulting in its
fibrosis.
The vein is localised and catheterised under
ultrasound guidance. A laser fibre is placed at the sapheno-femoral
junction at the groin and withdrawn slowly while delivering the
laser energy at the tip.
Protein coagulation of the vein wall results
in instant contraction of the vein, closing it around the
withdrawing fibre. The vein remains closed and fibroses and
disappears over the following weeks.
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Laser generator
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In the Minamilly Invasive Treatment Unit (MITU) located on the
third floor of 149 Harley Street, the procedure is carried out
under local tumescent anaesthesia and takes less than 1 hour.
The patient can stand and walk at the end of the procedure.
Wearing a compression stocking for a week following the treatment,
they can return to normal daily activities and work, almost
immediately.
Results and Complications
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Surgery
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RF(VNUS)
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Laser
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DVT
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1-5.3%
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3% (1 PE)
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0
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Parasthesia
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10-20%
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8.5%
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1%
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Skin burn
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N/A
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3.3%
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0
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Recurrence/
Failure
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18-40% at 5yrs
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10%
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2-7%
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| Return to
work* |
12.4 days
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4.7days
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<1 day |
The reported successful closure rate is 97% in
a meta-analysis of over 2,000 patients treated by laser ablation,
with no late recurrence at up to 5 years follow-up. Patients
avoid the risks and complications associated with general
anaesthesia, hospitalization and surgical complications and there
is no scarring. Patients can return to normal activities and work
within 24 hours.
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Before treatment
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10 days after Laser treatment
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We offer Laser treatment (ELVeS) as a minimally-invasive
alternative to surgery. Under local anaesthetic, it takes less than
1 hour with immediate return to normal activities.
With 98% success at 5yrs follow-up (c.f.
surgery 20% recurrence at 5yrs) it may also encourage earlier
treatment and so help reduce the incidence of secondary
complications such as venous ulceration.
Information provided by Dr Jocelyn
Brookes MBBS MRCP FRCR (Consultant Endovascular
Radiologist)
General Disclaimer
This page is designed for educational purposes only and is not
engaged in rendering medical advice or professional services. The
information provided through these pagess should not be used for
diagnosing or treating a health problem or a disease. It is not a
substitute for professional care. If you have or suspect you may
have a health problem, you should consult your health care
provider.