Say Goodbye to Varicose Veins: Understanding EVLA

Varicose veins in the lower extremities are a condition characterized by the enlargement and twisting of veins due to excessive pressure.

Varicose veins can vary in size and severity, and there are different treatment options available.

Based on the need for anesthesia during surgery, these are some common types of varicose vein surgery:

➤ Varicose Vein Surgeries Requiring Anesthesia

• Ligation and Stripping: This is a traditional surgical procedure performed under anesthesia. The surgeon will ligate (tie off) the affected vein and remove it by stripping it out of the patient's body.
• Endovenous Laser Treatment (EVLT): A laser fiber is used to deliver energy to the affected vein, causing the vein wall to contract and eventually close.
• Radiofrequency Ablation (RFA): Radiofrequency energy is used to heat the vein wall, causing it to contract and close.
• Minimally Invasive Vein Surgery (MIVS): The surgeon uses small incisions and special instruments to access the vein and perform repairs.
• Venaseal: A medical adhesive is used to close the diseased great or small saphenous vein, achieving the desired therapeutic effect.

➤ Varicose Vein Surgeries That Do Not Require Anesthesia

• Sclerotherapy: This is a non-surgical treatment that does not require anesthesia. In sclerotherapy, a special solution is injected into the affected vein, causing the vein walls to stick together and close.
• Surface Laser Treatment: This is also a non-surgical treatment that does not require anesthesia. Surface laser treatment involves heating small varicose veins to cause them to shrink.

At Chiayi Chang Gung Memorial Hospital, we commonly use two types of laser procedures for varicose veins: Endovenous Laser Treatment (EVLT) and Venaseal, often complemented by Sclerotherapy.

Does laser treatment for varicose veins hurt?

Unlike traditional open surgery, EVLT doesn't require general anesthesia, and it leaves smaller wounds and scars. As a result, postoperative pain is less, and hospitalization is unnecessary.

Dr. Huang will personally answer the common questions about laser varicose vein treatment found on Dcard and PTT! Let’s dive in!

What is the procedure for EVLT?

➤ Pre-operative Planning

We will use ultrasound to evaluate the patient for venous insufficiency (venous reflux). If the patient is suitable for minimally invasive treatment, we will arrange for a "MRI" to plan the subsequent surgery.

At the same time, an anesthesiologist will be consulted to recommend the best anesthesia method.

➤ Surgical Procedure

1. Marking: After anesthesia and before starting the surgery, an ultrasound is used to confirm the location of the veins to be treated, and these veins are marked on the skin.
2. Puncture: The doctor will insert a thin wire into a vein through a small puncture in the skin at the treatment site.
   The wire is then advanced to the treatment area.
3. Laser Fiber Placement: A laser fiber is passed through the puncture site and into the correct position within the affected vein, then delivers laser energy to the vein.
4. Position Confirmation: Before treatment begins, the position of the fiber is carefully checked, and the laser power is set.
   A special solution is then injected to protect the surrounding normal nerves and tissues.
5. Treatment: Once everything is ready, the laser energy causes the vein wall to contract and close, improving blood flow and relieving the pressure of the varicose veins.
6. Closure: After the treatment is complete, the laser fiber is removed from the vein, and a small bandage is placed over the puncture site.
   Usually, elastic stockings are worn immediately after the procedure.

➤ Post-operative Care

Patients may experience mild pain or discomfort for a period of time after surgery. It is recommended to use pain medication to alleviate these symptoms.

Here four tips of post-operative care of varicose vein surgery:

• Avoid standing or sitting for long periods
• Get plenty of rest and elevate your legs
• Avoid the surgical wound when showering
• Follow the doctor's instructions for wound care

Is Minimally Invasive Laser Surgery for Varicose Veins Expensive?

If a patient undergoes EVLT due to medical conditions, like bleeding, limping, chronic wounds, or inflammation, Chiayi Chang Gung Memorial Hospital currently bills the National Health Insurance for hospitalization, anesthesia, and varicose vein laser surgery.

However, the minimally invasive medical devices such as laser fiber catheters, Venaseal, and sclerosing agents are not covered by the National Health Insurance.

The cost of minimally invasive laser surgery for varicose veins varies slightly from one hospital to another and is generally assessed during consulting.

Generally speaking, the total cost of minimally invasive laser treatment for one leg at Chiayi Chang Gung Memorial Hospital in a general ward is approximately NT$80,000 to NT$90,000 (as of 2023).

However, the exact cost of varicose vein surgery still depends on the severity of the patient's condition.

Potential Complications and Side Effects of EVLT

After a thorough pre-operative assessment and when performed by an experienced medical team, varicose vein laser surgery has a very low risk of major complications or side effects.

However, some patients may experience temporary skin redness or bruising.

Additionally, some patients may experience mild numbness around the inner ankle due to the treatment.

If the varicose veins are severe, there may be some skin pigmentation in the superficial skin area, which may improve over time.

Varicose Vein Laser Surgery Frequent FAQs

Q: How long does varicose vein laser surgery take?

Generally, varicose vein laser surgery takes about one hour.

Q: Which areas can be treated with EVLT?

Minimally invasive varicose vein laser surgery is mainly used for the great saphenous vein and small saphenous vein.

Other areas, such as varicose veins in the vulva, are treated with Sclerotherapy.

Q: What post-operative care should be taken to prevent recurrence?

If possible, patients should avoid sitting or standing for long periods.

And it is best to use compression stockings correctly, especially during long periods of work or travel.

To get rid of the discomfort of varicose veins, minimally invasive varicose vein laser surgery is a safe and effective treatment.

Patients who have concerns about this condition or have questions about the cost of varicose vein treatment are welcome to consult us.

Q: Is varicose vein laser surgery covered by insurance?

The surgical coverage provided by different insurance companies varies.

Whether or not a claim is paid depends on the surgical items listed in the insurance policy, it is recommended that you carefully read the relevant terms of the surgical claim before surgery and confirm with your insurance company.