In 1999, a doctor in New York called Robert Min, decided that, if veins could be destroyed by heat, a laser could be used as effectively, if not more effectively, than with the VNUS Closure® device.
As such, he patented a laser fibre that could be passed up the vein in exactly the same way as the venous closure catheter, which then destroyed the vein wall when the laser was fired.
The major advantage of using the laser over VNUS Closure®, was that firstly was much quicker enabling the whole vein to be treated in approximately two minutes, whereas the venous closure technique required twenty to twenty-five minutes for the vein. In addition, the endovenous laser technique could be performed under local anaesthetic using a technique called tumescence. Using tumescence, very large quantities of local anaesthetic and normal saline are placed around the vein under ultrasound control. This closes the vein down onto the catheter, or laser fibre, and cools the outside of the vein, preventing heat damage to the surrounding structures.
Therefore, using this technique, vein experts were able to start treating patients under local anaesthetic using EVLA to destroy the major vein trunks.
However, one of the drawbacks of EVLA is that the laser creates so much heat that it often burns holes in the vein causing considerable bruising in some patients.
Our experience of EVLA at The Whiteley Clinic has generally been very good in that it has allowed us to perform varicose vein surgery under local anaesthetic with a very high success rate but approximately 25% of patients do get considerable pain or bruising after the procedure. However, in many people with very large veins, older veins with thin walls, or veins with either bulges or old scars inside, endovenous laser ablation is still the first choice treatment for the vein trunks.
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