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Endovenous Laser Ablation (EVLA) is a minimally invasive, image-guided technique used to treat Chronic venous insufficiency (CVI) and varicose veins, primarily due to saphenous vein reflux. It is a form of endovenous thermal ablation that uses laser-generated thermal energy to achieve vein closure through endothelial destruction and fibrosis.

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Indications

Indication Examples
Symptomatic varicose veins Aching, heaviness, swelling, fatigue
CEAP class C2–C6 From varicose veins to active venous ulcers
Great or small saphenous vein incompetence Confirmed on duplex ultrasound
Failed conservative therapy Compression, lifestyle changes

2. Procedure Overview

Step Description
Access Percutaneous cannulation of the affected saphenous vein under ultrasound guidance
Laser fiber insertion Positioned 1–2 cm distal to the saphenofemoral or saphenopopliteal junction
Tumescent anesthesia Injected around the vein to:
– Compress the vein
– Protect surrounding tissues from heat
– Provide analgesia
Laser energy delivery Thermal energy from the laser tip heats the vein wall (temperature ~800–1200°C at the tip), causing coagulative necrosis
Catheter withdrawal Done slowly as energy is delivered along the vein
Post-procedure Compression bandaging and ambulation advised immediately

3. Laser Parameters

Parameter Typical Value
Wavelength 810–1470 nm (1470 nm preferred for less post-op pain and bruising)
Energy dose 60–100 J/cm vein
Pullback rate 1–3 mm/s depending on protocol and laser used

4. Imaging Guidance & Follow-Up

| Pre-procedure | Duplex ultrasound to map reflux and measure vein diameter |

| During procedure | Real-time ultrasound guidance for access and fiber positioning |

| Post-procedure (1 week – 1 month) | Duplex US to confirm vein occlusion, rule out EHIT or DVT |

5. Advantages of EVLA