What is the principle of endovenous varicose vein treatment?
Since 1998, endovenous therapy has provided an alternative approach to treating varicose veins. This method relies on either heat (thermal method) or sclerosing agents (chemical method) to close and seal the varicose vein without the need for invasive incisions.
Endovenous varicose vein treatment revolutionized the therapy of varicose veins by introducing the concept of internal intervention without surgical incisions. Traditionally, the stripping procedure was considered the gold standard. In this method, the varicose vein was removed through a skin incision in the groin area, cut off, and pulled out with a metal probe.
EVLT utilizes a thin laser fiber inserted into the vein through a tiny puncture site. The laser heats the vein wall, causing controlled damage that seals the vein shut. Similarly, radiofrequency therapy uses electromagnetic waves to heat and close the vein wall. In the chemical method, sclerosing agents such as alcohol-based solutions are injected into the vein, causing an inflammatory reaction that seals the vein.
One outstanding advantage of these endovenous procedures is the elimination of the need for groin incisions, as required in traditional stripping procedures. This makes the treatment less invasive, reduces the risk of complications, and leads to faster recovery and an improved patient experience.
Is EVLT as effective as stripping?
EVLT has proven to be an extremely effective method for treating varicose veins, as numerous European and American studies confirm. Studies show that after a period of three years, only three percent of all treated patients show a reopening of the treated vein. This success rate even surpasses that of the traditional stripping method. With stripping, the previous gold standard of varicose vein treatment, the diseased vein is removed through a skin incision in the groin area by cutting it off and pulling it out with a metal probe. Although stripping is still commonly used, it is known to be associated with some risks and complications, such as pain, bruising, and scarring.
In comparison, EVLT offers many advantages. It is less invasive, as no cuts in the groin area are required, and has a lower complication rate. EVLT can also be successful in cases of recurring varicose veins after a stripping operation or in cases of mild varicose veins.
However, it should be noted that EVLT should be used with extreme caution in very slim patients with little subcutaneous fat tissue or when treating veins in the lower leg. In these cases, there is a risk of skin burns from the heat of the laser. To minimize this risk, a cooling fluid is injected next to the vein during the procedure. This fluid often contains a local anesthetic, which helps to cool the tissue and alleviate postoperative pain.
How quickly does an aneurysm need to be operated on?
The 5-year survival rate for an aortic aneurysm typically ranges from 60 to 75% and is mainly influenced by existing cardiovascular risk factors.
An aortic aneurysm is a progressive condition in which the risk of rupture, or the tearing of the artery, increases with the size of the aneurysm. When the diameter of the aneurysm exceeds eight centimeters, a rupture occurs in about 25% of cases. The prognosis after a rupture is poor, as about half of the patients die despite emergency surgery.
The risk of rupture depends on various factors, such as the speed at which the aneurysm develops, the size of the aneurysm, and the underlying causes. Early detection and treatment of the aneurysm thus contribute to minimizing the risk of these serious consequences and optimizing life expectancy.
How does EVLT proceed exactly?
Endovenous laser therapy always begins with a thorough consultation, during which I inform my patients about the procedure and answer their questions. It's important to me that they are well-informed and comfortable before we start the treatment.
The actual procedure is performed in my practice and begins with the injection of a tumescent solution into the tiss
ue. This solution sedates and cools the treatment area, ensuring that the patient doesn't feel any pain during the procedure. I then puncture the varicose vein just below the knee joint, either by naked eye or using ultrasound to determine its exact position.
Once the puncture site is prepared, I insert the probe of the laser device into the varicose vein and slowly advance it to just below the groin. Throughout this process, I continuously monitor the position of the probe using ultrasound to ensure that it is inside the vein and that the treatment is precise. When the probe is correctly placed, I deliver laser pulses to sclerose and seal the vein wall from the inside. This process typically takes about 30 to 45 minutes and is performed on an outpatient basis, allowing most patients to go home shortly after the procedure.
After completing the treatment, I apply a special compression bandage to support the adhesion of the vein wall and reduce postoperative pain. Additionally, I recommend wearing medical compression stockings for about two weeks after the procedure. This helps with the healing process and minimizes potential swelling. Follow-up care is extremely important for the success of the treatment, therefore I monitor it carefully to ensure that the patient recovers well and no complications occur.
What are the advantages and disadvantages of endovenous laser therapy?
The advantages of EVLT include its almost painless nature. Compared to traditional stripping surgery, it is less uncomfortable for many patients. Moreover, EVLT does not require bed rest after the procedure and has a shorter recovery time. Since no major surgical wounds are created, there is less postoperative pain and bruising. Patients can often resume sports activities as early as two weeks after the procedure. Also, EVLT typically leads to better cosmetic results than stripping.
Despite these advantages, there are some potential disadvantages of EVLT. These include, although quite rare, an increased risk of venous inflammation and thrombosis. There is also a risk of perforation of the vein wall during the procedure. Perforation occurs when the wall of a vein is accidentally punctured or penetrated.
EVLT is not suitable for all types of varicose veins. In cases of highly twisted veins, superficial varicose veins, or varicose veins on the lower leg, EVLT may be less effective and may potentially cause skin burns. Nevertheless, EVLT is a promising alternative to conventional varicose vein treatment.
What complications and side effects are possible with EVLA?
EVLT generally carries a low risk of complications. However, like any medical procedure, some side effects may occur. These include potential sensory disturbances, skin discoloration, venous thrombosis and bruising. Less commonly, more severe pain may occur in the area of the treated vein.
Compared to traditional surgical stripping, complications with EVLT are generally less common. While bruising often occurs, it usually has no clinical significance. Occasionally, deep vein thrombosis may develop, especially if blood clots form at the junction of the main vein into the deep venous system. Postoperative pain is also possible. The risk of nerve damage increases the closer the treatment is to the foot. Rarely, spider veins may form at the treated sites, a condition known as "matting." Very rarely, skin burns may occur.
Despite these potential side effects, EVLT remains a very safe and effective method for treating varicose veins.
What should I consider after EVLT?
Following endovenous laser therapy, the body experiences minimal strain, and most patients can resume their regular activities within a week. After the procedure, I typically apply a compression bandage, which you should wear for approximately 24 hours. Additionally, I advise my patients to wear compression stockings for an additional two weeks to help the healing process.
The day after the treatment, I do an ultrasound examination of the treated area. This allows me to monitor the healing progress and ensure that everything is proceeding as expected. About a week after the procedure, we schedule a follow-up examination. During this appointment, I reassess the condition of the treated area and discuss the next steps and recovery process with my patients.
When can I return to work and exercise?
Most patients can typically return to work within two to seven days after endovenous laser therapy, depending on the nature of their job. If your work involves mainly sitting or standing, you may be able to return sooner than those with physically demanding tasks.
Resuming sports activities is also an option early on. However, I recommend starting with lighter activities, such as walking, to promote circulation before gradually incorporating more strenuous exercises. After one to two weeks, you can usually engage in more demanding sports, but it's important to take it easy and listen to your body to avoid overexertion.
Traveling is usually possible after about ten days post-procedure. However, it's crucial to take sufficient breaks during the journey to move around and relieve the legs, especially during longer flights or car rides. This helps prevent complications and promotes better circulation during the travel period.
How much does endovenous laser therapy cost?
The costs of EVLT can vary depending on the individual assessment. It's important for me to evaluate your situation carefully to give you an accurate estimate. During our consultation, I take the time to answer your questions and provide you with all the necessary information.
If you are interested in the treatment of varicose veins with modern methods such as endovenous laser therapy and would like to find out about the costs and coverage by your health insurance, I invite you to schedule a personal consultation in my clinic.
Which health insurance covers endovenous laser therapy?
For individuals covered by statutory health insurance, the costs of varicose vein treatment is generally covered if it is deemed medically necessary. However, usually only traditional methods such as stripping are fully or partially reimbursed by insurance.
Other treatment methods such as endovenous laser therapy are partially covered by private health insurance companies. Many private supplementary insurances cover the entire cost of such procedures, and some even offer the option of direct billing. Therefore, I recommend that you schedule a personal consultation to discuss your individual needs. This way, we can ensure that you receive the best possible treatment, and all aspects of your therapy are clarified.
I look forward to welcoming you to our clinic and assisting you with your concerns.
