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Questions and answers about varicose veins and endovenous laser treatment (EVLT)

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Varicose veins

What is a varicose vein?

A varicose vein is a diseased superficial vein. It is dilated and its
are incontinent.
The last valve, called the ostial valve (the closest valve to the deep vein) is the most important because when it functions normally, or is continent, it prevents reflux from the deep vein into the superficial network.

Why is the ostial valve so important?

The ostial
The deep network is subject to higher pressure than the superficial network. In case of
of the ostial valve, the superficial venous network and the incontinent saphenous vein in particular, are subject to an increase in pressure that leads to varicose dilatation.

Can reflux occur in other areas than the ostial valves in the saphenous veins?

Yes, perforating veins that connect the superficial to the deep venous network normally have valves which allow blood to flow only from the superficial network into the deep venous network, but they, too, can be incontinent.
In this case, they subject the superficial venous network to hyper pressure coming from the deep venous network.

How does venous return work?

Physiologically, it works according to 4 principles:

  • The venous muscle pumpCompression of the veins in the sole of the foot during walking. There are both superficial veins (Lejars' venous plexus, which is composed of veins with a diameter of less than 1 millimetre in the skin) and deep veins (reservoir of venous blood collected in 2 double plantar veins).
  • Compression of the deep veins in the limbs from the ankle to the groin by the skeleton muscles.
  • Aspiration of venous blood during breathing (suction effect).
  • The arterial pulse which partially compresses veins by contact with arteries.

How can a large vein be distinguished from a varicose vein?

Clinical examination and above all a
Duplex scan
allow the practitioner to assess and quantify reflux in relation to
valvular incontinence.

It's this reflux that constitutes the main source of venous disease complications.

Why do varicose veins need to be treated?

  • To avoid complications (ulcers, phlebitis, haemorrhages)
  • To make the symptoms disappear: heaviness, pain, oedema, restless legs syndrome, pins and needles, cramps, and itching.
  • To improve cosmetic appearance.

Do all large visible saphenous veins need to be treated?

No, some great saphenous veins that are very superficial and sometimes slightly dilated are visible but maintain a normal
valvular continence
, for example among athletes and tall people.

What is phlebitis or vein thrombosis?

A vein obstruction caused by a blood clot.
It can occur in a deep vein (deep vein thrombosis, DVT) or in a superficial vein (SVT).

Can I wait before having an operation on varicose veins?

It depends on the extent of
detected by the
Duplex scan
, on the time you have had venous disease, and on the symptoms or the already existing complications.
As a rule, the sooner, the better.

Should I wait until I no longer want to become pregnant before treating varicose veins?

This is absolutely incorrect.
It's better to treat varicose veins before even the first pregnancy if necessary. Indeed, during pregnancy symptoms are often aggravated and the risks of varicose phlebitis are more important. If phlebitis develop it is more difficult to treat them during pregnancy.

What about the contraceptive pill?

The contraceptive pill is inadvisable in the presence of proven venous disease.
It is highly inadvisable in association with smoking.
The contraceptive pill is not advised if you have already had a superficial or a deep phlebitis, or in the case of a family disease causing phlebitis (

Endovenous laser treatment

How does EVLT work?

Laser is a light source which is turned into heat at the tip of the fibre in order to burn and destroy the varicose vein from the inside.
The vein is definitively closed up.

What is tumescence?

Tumescence acts as a liquid insulator around the varicose vein in order to protect surrounding tissues from any burning. It also serves to compress the varicose vein against the fibre in order to reduce its volume and therefore the intensity necessary to destroy the varicose vein. It's a mix of physiological serum and a small dose of lidocaine (local anaesthetic). Current practise is to refrigerate the tumescence at around 5°C so it will remain viscous during the whole procedure. It is the viscous nature that allows the tumescence to remain in contact with the varicose vein for the longest possible time.

What happens to the varicose vein after the laser treatment?

The varicose vein undergoes fibrosis: it retracts and disappears within 2 to 12 months. It is reabsorbed by your body, much like the umbilical vessels after childbirth.

Where does the blood flow after the destruction of a varicose vein?

Blood is diverted through other superficial veins, which are very numerous and allow a better venous return. Of course there is a risk that some of these veins can become varicose during the progression of this chronic varicose disease, hence the absolute necessity of an annual
to detect the emergence of new varicose veins as soon as possible and determine a therapeutic strategy adapted for their treatment.
Even during the treatment of a large number of varicose veins, we must bear in mind that the superficial network, to which veins belong, accounts for only 10 to 15% of the total venous return from the lower limbs. It's the deep venous network that accounts for 85 to 90% of venous return.

Does EVLT hurt?

No, in general the patient should feel no pain during the procedure. If this is not the case, you should immediately tell the practitioner who will adapt either the intensity or the speed of the withdrawal of the fibre, or will insert more tumescence.
Your vigilance, due to anaesthesia by simple tumescence, ensures optimal security and avoids perivenous burns as you will be able to feel them immediately and alert the practitioner.

What happens after EVLT procedure?

A dose of
is injected at the treatment table and the patient is fitted with compression tights or stockings.
You can leave the doctor's surgery immediately after this procedure but you must be accompanied: you are not permitted to drive a vehicle after local anaesthesia. You can drive again the next day and usually plan your return to work between 0 and 5 days after treatment.
Restarting a sporting activity depends on postoperative pain, which varies from one person to another but is generally possible within 5 to 30 days. If necessary, return flight or car trip is possible under heparinotherapy in the days following the procedure.

What are the results of EVLT?

In 95% of cases EVLT allows the immediate occlusion of the varicose vein treated, with repermeation rates closer and closer to 0% at 5 years.

What happens in the case of coronary or artery bypass?

A varicose vein is not an effective
prosthetic material
and in the vast majority of cases, it is not suitable for a permanent bypass.
Other superficial veins exist such as possibly mammary arteries which could be considered for a coronary bypass.

Contraindications to endovenous laser treatment

I already had a surgical treatment of varicose veins, can I benefit from EVLT?

Endovenous techniques such as EVLT and
foam sclerotherapy
are frequently the most adapted techniques to treat the recurrence of varicose veins.
However, traditional surgery is sometimes necessary for more limited operations as a complement to these endovenous techniques.

I have already had sclerosis, can I be treated by endovenous laser?

There is no single answer for every patient. A
Duplex scan
can provide the answer.

Is there an age restriction for this treatment?

There is no real age limit for endovenous laser among people with good general health. The technique is minimally invasive and only requires a light local anaesthesia.

Is excess weight a contraindication?

There are multiple lengths of
, so endovenous laser therapy can be adapted to most morphologies. Moreover, it avoids a scar in the groin area where the great saphenous vein is accessed. This scar is prone to complications during surgical operations.


3 points to remember

Traitement des Varices par Laser Endo-Veineux (LEV)A Duplex scan is indispensable in order to make a proper diagnosis and to determine the appropriate therapeutic indication.

Traitement des Varices par Laser Endo-Veineux (LEV)An annual Duplex scan and clinical examination is essential whatever the initial technique chosen.

Traitement des Varices par Laser Endo-Veineux (LEV)Proper treatment and follow-up of varicose veins may prevent many complications, which may be irreversible.

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