Endovenous LASER ablation (EVLA) utilises a thermal-based LASER catheter to heat seal the vein. The technique requires the use of local anaesthetic tumescent along the length of the treated vein to dissipate the thermal energy, protect the saphenous nerve and sural nerve that run with the GSV and SSV respectively and provide initial analgesia. When compared to surgical stripping initial occlusion rates and longer term (1-3 year) recurrence rates for thermal endovenous ablation with EVLA are similar to or better than surgical stripping [11, 16].
A technical limitation of EVLA is that it is mainly used for main truncal (GSV/SSV) ablation, whereas perforator veins require other treatment options.
Complications from EVLA include[11]:
- thrombophlebitis, which is the most common complication of EVLA, occurring in up to 7% of patients due to inflammation of the treated vein. This commonly presents within the first month, is self-limiting and responds to non-steroidal anti-inflammatories (NSAIDs) and other simple analgesia agents.
- bruising and haematomas, however at rates less than surgical stripping.
- DVT which occurs in less than 1.3% of cases. The role for pharmacologic prophylaxis is unclear but is recommended for high-risk patients. Treatment with therapeutic anticoagulation is indicated when the thrombus extends into the common femoral vein. Pulmonary embolism has been reported after EVLA with a rate of up to 3%.
- thermal injury and paraesthesia occurs in 1-2% of cases, as the energy dissipates through adjacent tissues.
- Hyperpigmentation.