Procedures

In the standing position blood must return to the heart from the legs against the force of gravity. Normally there are valves present along the course of the veins which allow blood to flow in only one direction - upwards toward the heart. If the valves are defective and do not close properly blood will flow backwards causing pooling of blood in the leg veins and bulging of the vein walls. The large veins are unsightly and may be accompanied by skin discoloration and, in extreme cases, the formation of ulcers which are very difficult to heal.

Patients with this condition may also complain of "heaviness" or aching in the legs.

Unsightly veins in the legs caused by vein reflux disease is a very common problem - up to 25% of all women and 18% of all men suffer from vein reflux disease to some degree.

Valve failure in the major leg vein (the greater saphenous vein) is the most common cause of vein reflux in other parts of the leg. Most often veins visible in the lower thigh, knee and calf are due to vein reflux in this major vein.

• Heredity - The tendency for valves to be defective is often inherited.
• Gender - Women have a higher incidence of vein reflux disease due, in part, to the female hormones affecting the structure of the vein walls.
• Pregnancy - Pregnancy can cause an increase in venous blood pressure, which results in more pressure and stress on the walls of the vein. Hormones are also a factor.
• Age - As we age, our tissues lose elasticity, resulting in weakened vein walls and valves.
• Prolonged Standing - The volume and pressure of blood in the lower limbs is affected by gravity, so the longer you stand the greater the effect.

The goal of treatment is to prevent backflow in the long saphenous vein in the thigh which causes increased pressure in the veins of the calf and thigh which causes them to enlarge. This goal can be achieved by surgery or EVLT.

The traditional surgical treatment for varicose veins consists of "stripping" the long saphenous vein in the thigh. This procedure completely removes the vein through incisions in the groin and either the ankle or knee. A general anesthetic is required and patients must be admitted to hospital.

EVLT is a quick, minimally invasive laser procedure that can be performed in your doctor's office. There is no post operative scarring, as only a thin plasic probe enters the vein via a tiny skin nick.

The probe is guided into place using ultrasound. The procedure is performed under local aesthetic similar to that used by dentist to numb the treatment area. Once the laser probe is in position the laser is activated and the probe slowly removed over a time of about 60 seconds. The laser acts on the wall of the vein as it is removed effectively obliterating it. During this procedure the patient may experience heat along the course of the vein but there is no pain. The whole treatment takes less than an hour. Normal activities can be resumed immediately.

• Immediate relief from symptoms
• No scars
• Only a local anesthetic is needed
• Can be performed in the doctor's office (no hospitalization needed)
• Treatment in less than an hour
• Normal activities can be resumed immediately - with little or no pain

Although approved by Health Canada in 2003 the EVLT procedure is considered primarily cosmetic by the Ministry of Health and the cost is therefore not covered by Medicare. This is the only procedure performed at The Toronto Vascular Institute which requires the patient to pay for their treatment. If you have private insurance you should check whether your benefits will cover this treatment.

http://www.diomedinc.com/content/patients/about-evlt/index.jsp

http://www.diomedinc.com/pdf/jvir-brochure.pdf

http://www.evlt.ca/index.html