EVLA stands for endovenous laser ablation. It is an effective method for getting rid of varicose veins, a condition caused when vein valves do not close correctly, and thereby allowing blood to pool in the affected area. Veins begin to bulge as blood pushes against the vein walls. The result is painful, causing legs to ache and swell. In worse case scenarios, varicose veins can lead to unnecessary bleeding and eczema or ulceration. About 50% of patients with venous disease get a deep venous thrombosis (DVT) and about 50% get an ulcer.

During the EVLA procedure, the skin is numbed with local anesthesia, a tiny laser fiber is inserted into the skin and guided to the saphenous vein through ultrasound imaging. The vein is surrounded by an anesthetic liquid and then the laser fiber gently closes the vein as the fiber is removed. This part of the procedure usually takes two or three minutes and is painless. Now that the vein is closed, the abnormal high pressure in the leg is reduced immediately, making it easier for the surrounding healthy veins to do their job returning blood to the heart. The normal pressure in the leg helps reduce the chronic congestion in the leg, the symptoms decrease and leg returns to normal health. The entire procedure takes less than 25 minutes and you are usually in and out of the office in about an hour.

Not all endovenous thermal procedures are the same. Some of the earlier lasers actually cauterize the vein. The cauterization can create more post op discomfort. California Vein Specialists uses only the latest, most gentle laser frequency (1470 with a radial head). Dr. Leary also uses the Venous ClosureFast, also known as Venefit, which is powered by radiofrequency (RF), delivering heat to the vein wall. As the thermal energy is delivered, the vein wall shrinks and the vein is sealed closed. This method is also very gentle with very little post op pain. Every procedure is tailored to the particular needs of the patient. Some patients will be better candidates for laser, while some may be better candidates for radio frequency. Dr. Leary will discuss and recommend which of these options he feels is best for each individual patient.

EVLA addresses the source of varicose veins without an invasive surgical procedure like ambulatory phlebectomy, ligation and stripping. It uses a fiber laser energy probe, guided by ultrasound, to deliver impulses to the affected area. It is highly effective, working 98 percent of the time*.

Patients with arterial or blood disorders may not be eligible for this procedure. Pregnant women are not immediate candidates either since, in many cases, temporary varicose veins disappear after pregnancy. This minimally invasive procedure is an excellent choice for a large number of patients that are at higher risk for surgery; for example diabetics and patients on blood thinners.

A physician evaluation, including a medical history, physical exam and ultrasound are required before EVLA. Additionally, you will be prescribed post-surgical compression hosiery for five days. Just before the procedure, patients are asked to shower with antibacterial soap.

EVLA is done out-patient and takes less than thirty minutes. The patient can usually drive themselves to the office and drive home. Only a local anesthetic is given before EVLA begins. Patients are also offered a pair of protective glasses to wear. Then, a small catheter is threaded into the vein entering usually from below the knee. The laser fiber is gently advanced through the catheter and, once in place, uses its energy to seal off the vein. Then the laser fiber is removed, the wound dressed, and compression hosiery applied. The procedure is very gentle, the only discomfort felt are a few pinches during local anesthetic administration. Our newer lasers are very gentle and patients experience very little or no pain after the procedure.

Activity is encouraged following the procedure, the patient should walk several times per day for at least 20 minutes. Patients must wear a Grade 2 compression stocking for five days and are allowed to shower with the compression stocking on. A shower cover can be helpful to keep the compression stocking dry. Restrictions may be imposed, such as heavy lifting over the head and jogging. Patients are allowed to use a treadmill, and are allowed to do yoga and Pilates after the procedure. Painkillers like ibuprofen, acetaminophen or Aleve may be taken as needed, but usually are not needed. Sometimes mild stiffness and soreness are felt but usually disappear within two weeks.

A second ultrasound will be performed two weeks after EVLA and additional physician follow-up appointments will be necessary. Sclerotherapy, if needed, is usually started within two weeks. Most of our patients are advised to come in for yearly ultrasound evaluations.

Localized urticaria are small raised hive like bumps that may appear at the injection site, they may feel itchy and may appear red. They will usually resolve in a few minutes. Usually patients don’t notice them as soon as they put stockings on.

Hyper pigmentation is a brownish discoloration that occurs over the treated vein. It usually appears a few weeks after treatment. Hyper pigmentation is due to a hemosiderin (iron) deposition in the skin. Most staining clears gradually in about six months. Sometimes it will last up to a year and rarely over a year. Hypertonic saline causes more staining and if a sclerosant is too strong there is more risk of staining. Sometimes if areas of reflux are not treated (feeding veins) staining can occur. Certain people with high iron stores are more prone to staining and patients with more pigment in their skin tend to be more prone to staining. Also patients who are on Minocycline tend to stain. It is important to drain any trapped blood in treated veins, as the blood is the source of iron. Treatment for staining is usually tincture of time. IPL and some laser treatments may speed up the resolution. Bleaching agents are usually of no help.

Matting is an area of blushing or redness that can appear after sclerotherapy. Matting is made up of very small red telangiectasias or tiny red vessels. The cause of matting is unknown. Factors such as obesity or a family history of matting, excess estrogens may predispose to matting. Sometimes a vein that has not been completely closed may cause matting. Too strong of a sclerosant, such as hypertonic saline may cause matting and using too much pressure when injecting may cause matting. Most matting will resolve on its own but at times can remain permanent. When matting occurs meticulous search for a cause should be sought, this includes ultrasound exam and transillumination to find small feeding veins that may have been missed. Laser may also work to remove matting.

Patients with arterial or blood disorders may not be eligible for this procedure. Pregnant women are not immediate candidates either since, in many cases, temporary varicose veins disappear after pregnancy. This minimally invasive procedure is an excellent choice for a large number of patients that are at higher risk for surgery; for example diabetics and patients on blood thinners.

Cutaneous ulceration is a very rare complication of sclerotherapy. It is occurs with the use of hypertonic saline most commonly. Hypertonic saline is a sclerosant that we feel should not be used. It is not very effective and has numerous drawbacks. Ulceration can occur with other sclerosants but is very rare. If a small ulcer develops, they are usually small and will heal within a few weeks. Ulcers can leave dark shallow scars.

Deep venous thrombosis is a very rare complication of sclerotherapy. Studies have shown that the incidence of DVT is less than the incidence that occurs in the untreated general population. Important steps to avoid DVTs after sclerotherapy include wearing compression hose and being active.

Allergic reactions are very rare complications of sclerotherapy, but can occur with the use of any sclerosant.

Endovenous Laser Ablation (EVLA) is a minimally invasive, more desirable alternative for treating painful, unsightly varicose veins. With a 98% effective rate, varicose veins can be removed in the office, and the procedure allows patients to return to normal activity immediately.

Venefit, powered by radiofrequency, delivers heat to the vein wall. As the thermal energy is delivered, the vein wall shrinks and the vein is sealed closed. This method is also very gentle with very little post-operational pain.

Sclerotherapy is considered the gold standard of varicose vein treatments. The treatment generally consists of injecting the veins with a substance to absorb the vein without any other damage to the body. There are many different variations of sclerotherapy that can be performed to improve the likelihood of success, such as foam, cryo or ultrasound-guided sclerotherapy.

To keep patients comfortable, the use of nitrous oxide has been introduced in many sclerotherapy procedures. It provides the patient with a more relaxing experience. We have received an abundance of positive feedback since adding this as an option for people who are nervous about the procedure.

If your vein concerns are pointed primarily at your hands, then we offer hand sclerotherapy to help reduce the size of large, bulging veins. Huge improvements can be made in as little as one or two treatments.

The FDA approved Another Varicose Treatment in 2013. It is unique to other procedures in that it uses a foam substance to cut off the blood supply to a vein, effectively killing it and causing the blood to reroute to a different, healthier vein. It is used primarily in the legs and is considered to be an extremely safe treatment.

Choose low-impact activities such as walking, cycling, rowing and swimming. Walking and jogging will help improve circulation in the legs. Exercise can also reduce the overall high blood pressure and strengthen the entire circulatory system.

Try not to stand in one place for a long time because it can increase venous pressure in the legs and feet. Over time this pressure can weaken the blood vessel walls.

Having too much weight can cause the entire circulatory system to work harder. Being overweight can put excess pressure on your legs. It is good to exercise regularly and develop healthy eating habits. This can reduce the risk of varicose veins.

Smoking is terrible for your health and can cause many health problems. High blood pressure is associated with smoking which can cause varicose veins.

If you have to stand up for long periods, remember to take time to relax your legs. Improve circulation by elevating your legs up six to 12 inches above your heart when lying down. Doing this a few times a day will help the blood in the lower legs flow easily back to the heart. By taking some pressure off the legs, it will help prevent blood from pooling in the veins. Be sure to stretch your legs if you have to sit for long periods. Rotate your ankles and flex your toes while you are sitting.

Wear clothes that don’t constrict your waist, groin or legs. Avoiding tight-fitting clothes on your legs and around your waist will improve circulation to your lower body. Wear comfortable shoes and avoid wearing high heels. The stress they put on your lower legs can cause a constriction in blood flow from the leg back to the heart. Also, make sure your shoes are properly fitted.

Sit up straight and don’t cross your legs. Crossing your legs will slow the upward flow of blood back to the heart and increase the pressure on the insides of the leg veins. Good posture improves circulation and helps decrease pressure in your veins.

Long-term use of high-estrogen birth control pills has been shown to increase the risk of varicose veins by altering circulatory valve functioning.

If you’re developing varicose veins, try regularly using a compression hose (support hose). These come in a variety of different compressions. The pressure in the stockings is graded, allowing the stockings to constantly squeeze the leg muscles. This motion helps to drive blood back to the heart, reduce swelling in the feet and prevent blood clot formation.

Most insurances will cover varicose vein treatment if it is considered medically necessary and not just being performed for cosmetic reasons. To know for sure, you will need to contact your insurance provider or schedule a consultation with our office to start working on the process.

In the United States, about 2 million people per year develop deep vein thrombosis. Most of them are aged 40 years or older. Up to 600,000 are hospitalized each year for the condition. Deep vein thrombosis can lead to more severe complications like blood clots in the lung (pulmonary embolism).

I have many patients come to my office for the first time with phlebitis of the superficial veins. This is a condition that is rarely life-threatening and relatively common in patients with varicose veins. My concern is that many patients referred to my office have already been seen and diagnosed by their physician, and in my opinion, have not been properly diagnosed.

Statin drugs are used for cholesterol-lowering and have been proven to reduce the risk of serious cardiovascular events like fatal heart attacks and strokes. Statin drugs work by reducing the total cholesterol levels in the blood.

They work by blocking the key enzyme required by the body to produce cholesterol. Action statins can reduce inflammation throughout the body. This reduction in the body’s inflammation may even reduce the risk of some cancers.

Severe complications are extremely rare and unlikely. Endovenous procedures are minimally invasive and have much less chance of thrombosis when compared to older methods such as vein stripping. Endovenous ablation allows for safer, less expensive and superior cosmetic results.

Patients considering treatments should consult with a highly trained phlebologist who is familiar with all aspects of vein disease. Board certification in Phlebology is preferred. Phlebology is the specialty of venous disease. At California Vein Specialists, Dr. Michael Leary is board certified in phlebology and is a National Training Physician, training other Doctors from all over the US.

There is a lot of misinformation available online and a lot of old tales about varicose veins. Here are some popular myths that get a lot of attention and whether or not they are true:

• “Men do not get varicose veins.” False. Men are less likely to develop varicose veins but it is still possible.
• “Pregnancy causes varicose veins.” False. There is no association between the two.
• “Tattoos are bad for varicose veins.” False. There is no evidence to support this assumption.
• “Hard surfaces cause varicose veins.” False. There is no evidence to show a correlation between working or laying on hard surfaces and the development of varicose veins.
• “There are home remedies for varicose veins.” False. There is little to no scientific backing showing support for home therapies or most creams.
• “Crossing your legs causes varicose veins.” False. Cross all you want, it will not increase your chances of developing varicose veins. Just make sure you aren’t cutting off circulation.
• “If your parents had varicose veins, you will too.” Somewhat true. You are more likely to have varicose veins if you inherited the disposition from your parents, but it is always a dice roll like any other inherited trait.

Wear clothes that don’t constrict your waist, groin or legs. Avoiding tight-fitting clothes on your legs and around your waist will improve circulation to your lower body. Wear comfortable shoes and avoid wearing high heels. The stress they put on your lower legs can cause a constriction in blood flow from the leg back to the heart. Also, make sure your shoes are properly fitted.

Sit up straight and don’t cross your legs. Crossing your legs will slow the upward flow of blood back to the heart and increase the pressure on the insides of the leg veins. Good posture improves circulation and helps decrease pressure in your veins.

Long-term use of high-estrogen birth control pills has been shown to increase the risk of varicose veins by altering circulatory valve functioning.

If you’re developing varicose veins, try regularly using a compression hose (support hose). These come in a variety of different compressions. The pressure in the stockings is graded, allowing the stockings to constantly squeeze the leg muscles. This motion helps to drive blood back to the heart, reduce swelling in the feet and prevent blood clot formation.