NO VEIN,
NO PAIN…How a new procedure called EVLT (Endovenous Laser Treatment) works to combat varicose veins.

The Problem
In a normally functioning saphenous vein, (the large superficial vein draining the legs along the inner aspect of the thigh), the valves close preventing a back flow of blood toward the foot. Abnormal backflow called saphenous venous reflux is often the underlying cause of varicose veins. Factors such as pregnancy, excess weight, inadequate exercise or a damaged vein can lead to this often painful circulatory problem.

The Treatment
The procedure involves closing of the saphenous vein with a minimally invasive technique in which a catheter is inserted near the knee and placed into the vein. The catheter sends laser energy to the vein wall, causing it to close.

{A disposable catheter is inserted into the vein, the vein is warmed by laser energy and causes it to collapse, and the catheter is slowly withdrawn, closing the vein}

Patients experience noticeable improvement within 1-2 weeks with little to no scarring. Common side effects are temporary tenderness and numbness.
Susan Stevens says she spends eight hours a day on her feet as an operating room nurse, a job she has held for 30 years. As a result, over time she developed a varicose vein on her right thigh.
        “I wore support hose to work and did all the right things, but at the end of the workday, my leg would be swollen and throbbing and I’d have to elevate it,” says the 52 year old Spring resident.
        In October, she opted for endovenous laser surgery, a relatively new procedure for treating varicose veins.
        “I had the laser surgery on Friday and was back at work on Monday. And all I had was slight bruising from the catheter, but no more varicose veins,” she says. “It changed my life. I’m no longer in pain while I work. I love my legs now.”
        Several new therapies are making it easier for people to recover from varicose veins, those purple or blue, wormlike protrusions that most commonly occur on the back or inside of legs but also appear on the stomach, pelvis, labia and face.
        Dr. Christopher LaVergne, and Dr. Brenda Peabody are board certified in cardiovascular disease and highly trained phlebologists, offering state of the art treatment for varicose veins in a relaxed office setting.
        The seven physicians of Woodlands North Houston Heart Center have closed the gap of limiting vascular treatment to arterial disease alone and have adopted a “Total Vascular Care” approach. Venous disease has been around forever, Dr. LaVergne points out, but it somehow becomes ignored since the disease progresses over a long period and patients learn how to accept chronic but debilitating symptoms. Treatments were limited to vein stripping in the past and patients just did not want to be put through that. Dr. Peabody says that because varicose veins can be unsightly, for many people they’re a cosmetic issue that keeps them from exposing their legs in public. For others, the discomfort is physical, causing heaviness, swelling, itchiness, and a burning sensation in the legs.
        Between 10% and 35% of US population has some element of varicose veins says Dr. LaVergne, veins are thinner and much weaker than arteries. They may enlarge in response to heredity, trauma, pregnancy, and working conditions which require you to be on your feet. The result can be venous insufficiency or reflux, which is a pooling of venous blood that is unable to return from the leg to the heart. “Venous insufficiency itself leads to other complications, the most common of which are blood clots, phlebitis, ulcers, bleeding, infection, and a discoloration of the leg,” he said.

Treatment Options
        Dr. Peabody says “untreated varicose veins tend to worsen; in other words, once you have them, they won’t get better on there own.”
        As was the case initially with patient Susan Stevens, people can get temporary relief from discomfort by wearing compression stockings that support the ankle up through the calf. If that does not ease the pain, varicose veins can be removed surgically.
        According to Dr. LaVergne, until about five years ago the only such procedure was ligation and stripping, a major operation to remove the veins; it is done under general anesthesia. “Complications of the surgery include potential significant blood loss and prolonged recovery of two to three weeks and multiple scars on the leg,” he said. The procedure is still used in cases which the veins are larger than 12 millimeters in diameter or when the vein is twisted, there are now less invasive options that close the veins rather than remove them: endovenous laser therapy, or EVLT.
        Stab phlebectomy, also called ambulatory phlebectomy, is an outpatient method of surgically removing the veins. In addition, to treat spider veins and other small veins, sclerotherapy and superficial photo laser therapy are used.
        Which option your doctor recommends depends on which veins are enlarged, where they’re located and your symptoms.

Heat Therapy
        Dr. LaVergne and Dr. Peabody, co directors of Woodlands North Houston Heart Center’s Vein Center, say if an ultrasound examination determines that the saphenous vein, the long vein that runs from the groin to the ankle, is abnormal, the EVLT procedure is used to close the vein. This procedure can be done with only a pinhole incision to insert a catheter through which the vein is destroyed by heat energy, forcing it to collapse and eventually to be absorbed by the body. This is an outpatient procedure that takes about 1/2 hour to 45 minutes with little or no bruising, patients leave wearing an ace bandage, which can be removed the following day. Surgeries are often conducted on Fridays so patients can spend the weekend recuperating.

Additional Therapies
Patients often need additional therapy on the wormlike varicose veins that branch off the saphenous vein on the knees and below. These can be removed with a stab phlebectomy. The procedure is done under local anesthetic with small incisions that don’t require a suture. The vein is then pulled out with a crochet-hook-like device. Recovery from this surgery is the same as with the heat therapies.
        For veins that are too small to be removed by this procedure, usually less than 3mm, many patients opt for sclerotherapy through which an irritant like saline solution is injected into the vein, causing it to collapse. This option has been available for 30 years and is successful about 70% of the time and may require repeat treatments. It is recommended that you have sclerotherapy done in the winter to avoid skin darkening because of sun exposure. Patients can resume normal activity immediately.

{Dr. LaVergne inserts the laser fiber into the vein from a small needle puncture site on the leg of a patient during a varicose vein procedure at The Vein Center.}

        Spider veins are another form of varicose veins which appear as red or purple pen marks. Dr. Peabody relates they are commonly caused by sun exposure, heredity, and the normal aging process. For very small spider veins less than 1mm in diameter, superficial laser therapy is an option. It is done with the same machines as those for tattoo and hair removal, essentially a burst of light that ablates and fades the vein.

{Dr. Peabody performing photo laser therapy with a Cutera CoolGlide CV 1064nm Laser}


{Patient walking in the hallway of the heart center only 15 minutes after EVLT procedure}

To see if you are a candidate for treatment call The Vein Center at (832) 249-3728 to schedule an initial complimentary evaluation by our highly trained staff.