Endovenous Laser Treatment

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Many years ago, the standard way that varicose veins were treated was by a surgical procedure called “vein stripping”, where the vein was completely removed from the leg. Today, Endovenous Laser Treatment (EVLT) is the “Gold Standard” procedure offering superior results with limited side effects. This is usually the preferred treatment for veins that are wide and straight such as the Great Saphenous Veins and the Small Saphenous Veins. Once these larger veins are closed, it can relieve many of the patient’s uncomfortable symptoms and can even, as a result, remove some of the smaller spider veins. At the first, ultrasound based consultation Dr. Massoudi will let you know if EVLT is the best treatment for your veins.

The Endovenous Ablation procedure takes about 15 to 30 minutes and is done in any of our offices, including Beverly Hills, Encino, Irvine, and San Diego. A long tube is inserted into the vein, and energy is applied, using laser or radiofrequency to shrink and close the inadequate vein permanently.  This facilitates the blood to flow through healthy veins. This is a minimally invasive procedure that results in no visible scarring.

PREPARATORY CONSIDERATIONS:

Because this is an in-office procedure, it very simple and doesn’t require very much preparation on your part. However, we have a few recommendations for you before coming in for an EVLT, and we will remind you of these when calling to confirm the appointment:

  1. Please do not consume any caffeine the day of the procedure. This is the only important consideration prior to receiving this treatment.
  2. Please bring (don’t wear) your compression stockings. If you do not have stockings yet you may purchase them here.
  3. We recommend that you shower beforehand in order to keep the bandages clean and dry for 24 hours following the procedure.
  4. If you have an exercise routine, please plan accordingly because we will recommend no heavy lifting/vigorous exercise for two days following the procedure.

PROCEDURE:

    1. Medication: If necessary, a patient may be given a relaxation medication, or a mild anti-inflammatory agent.
    2. Sterilization: The leg will be prepped and draped in a sterile fashion to minimize any risk of infection.

Procedure:

  • A subcutaneous, local anesthetic is injected at the entry point.
  • Under ultrasound guidance, a needle in inserted into faulty vein.
  • Once this needle is inside the vein, a small wire is then threaded through the needle, and the needle is taken out.
  • Using a 2mm incision, a small tube called a catheter is then advanced over the wire, and into the vein in order to accommodate the laser fiber, or radio frequency ablation device. The laser tip or RFA device is advanced and will be placed 3 cm from the junction, so is far enough from junction, so there is no chance of DVT.
  • A numbing agent is then injected along the entire length of the vein to protect the surrounding tissue, minimize discomfort, and to milk out the blood from the vein.
  • Once the leg is numb, with the catheter in place, the laser device is turned on and the catheter is slowly pulled back through the vein allowing the heat from the laser fiber to thermally injure the lining of the diseased vein, closing it permanently.

Following:

  • Small, sterile, surgical tape called steri strips are placed over the entrance incision.
  • A prescription strength compression stocking is placed over the leg, and the leg is wrapped with a bandage to reinforce the pressure on the leg.
  • You will be instructed to walk for 20 minutes immediately after the procedure, and released to go home.
  • You will be able to drive, and resume your daily activities immediately.
  • You will have ultrasound follow up appointments after 1 week and 1 month to assess the efficacy of the treatment, and to rule out any post procedure complications.

Post Instructions:

  • You may take off the top bandages and compression stockings after 24 hours in order to take a quick shower. The steri strips should not be removed. They will eventually fall off on their own.
  • The stockings must be put back on immediately (no need to apply bandages). They should be worn during the day for at least 2 months, and only taken off for hygienic purposes.
  • We recommend that you are up, walking, and performing daily activities as much as possible.
  • Arnica, a homeopathic supplement, is recommended for bruising and swelling (5 pellets under the tongue, 3 times per day). You can purchase this at our offices, or find it in health food store.

OTHER PROCEDURES

You have probably heard of one or more of the following terms for laser vein treatments: Endovenous Laser Treatment (EVLT), Radiofrequency Ablation (RFA), Venefit, VNUS Closure, or ClariVein. These are all minimally invasive, FDA approved procedures that offer the latest advances in the treatment of varicose veins at the source. The differences between them are slight, and some are not different at all. All procedures listed above involve the injection of a local anesthetic, the insertion of a thin, catheter guided wire into the vein itself, and closing the vein by causing damage to the vein wall. However, the difference lies with the ways in which the veins are forced to collapse:

  1. Endovenous laser treatment (EVLT) is a medical procedure that uses energy from a laser in order to seal the defective vein by heating and shrinking the vein walls so blood does not flow through it; thus eliminating bulging veins at the source.
  2. Radiofrequency ablation (RFA) is a procedure that utilizes radiofrequency energy to heat and shrink the inside of vein walls, causing the vein to collapse and seal shut. Other procedures that use radiofrequency energy are: Venefit™ procedure or VNUS closure. http://www.venousinstitute.com/Venefit-Procedure
  3. ClariVein™ is a newer option that uses a combination of mechanical “irritation” and sclerosing solution to seal off the vein permanently. The mechanical action consists of a rotating wire inside the vein in order to disturb the lining, and does not use heat, unlike RFA and EVLT methods.

Dr. Massoudi specializes in minimally invasive and innovative cosmetic laser surgery. He has extensive medical experience coupled with his access and use of state of the art laser systems:

  • TVS™ 1470 Laser (Total Vein Systems)
  • ThermaLite™ 1470 Laser System
  • VenaCure EVLT® System
  • Venefit™ Targeted Endovenous Therapy
  • Sciton®
  • ClariVein™
  • Varithena

ADVANTAGES

    Today – EVLT

  • 30 minute in-office procedure
  • Only local anesthetic used (Tumescent)
  • High success rate (93-98%)
  • No scarring
  • No hospitalization
  • Lower risk of complications
  • Quick return to normal activities (1-2 days)

   60 Years Ago – Vein Stripping

  • Scarring
  • Hospitalization required
  • General or spinal anesthesia required
  • Surgical incisions requiring sutures
  • Long recovery

Potential complications following EVLT:

  • Infection: Here at Aluna Vein Centers, we are meticulous about strict sterile technique. Dr. Massoudi has not ever had a single case of infection in his 15 years of experience.
  • Bleeding: A maximum of 1-3mL can be lost during the procedure. Following the procedure, minor bleeding may occur, but can be relieved with 5 minutes of moderate pressure. There may be some blood-like secretions, which is normal. This results from excess numbing solution that was injected during the procedure leaking out.
  • Skin Numbness: Temporary. May last a few months, but does not interfere with activity. Dr. Massoudi uses an adequate amount of subcutaneous, local anesthesia in order to protect the nerves and prevent any permanent damage.
  • Deep Vein Thrombosis (DVT): Less than 1% chance risk. Dr. Massoudi goes further than the typical protocol before, during, and after his procedures in order to minimize any risks. Some of the ways he does this are: taking a detailed medical history of each patient to decrease the risk of blood clots, flushing out the blood from the defective vein before closing it, keeping an adequate gap between the deep system and the vein being closed to decrease the risk of DVT, and using enough Tumescent anesthesia in order to make sure not to cause any permanent nerve damage or numbness following the treatment. Dr. Massoudi also takes the ultrasound follow-ups with our registered vascular technicians very seriously.
  • Risk for DVT may be higher with:
  • Personal history of DVT
  • Family history of DVT
  • Preexisting clotting disorders
  • Certain medications
  • Recent surgery
  • Sedentary Life Style
  • Immobility
LA Vascular Specialists
Beverly Hills

8500 Wilshire Blvd., #518, Beverly Hills, CA 90211

(310)855-7171

(310)855-7262

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