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EVLT – (Endovenous Laser Treatment) endovascular laser, thermal ablation of veins

EVLT (Endovenous laser treatment)  can be explained  as intravenous obliteration of big, morbidly changed, venous trunks (great saphenous vein and small saphenous vein) and smaller branches.

The technique , under the control of  Doppler ultrasound, is based on the introduction of a special casing, through which a probe, so-called a fiber terminated with a laser light is inserted. The best tool for this type of treatment is a generator which produces a wave of 1470 nm and an optical fiber with a radial end.

This intervention can be done instead of a traditional operation (Babock method) which is a regular stripping , the classical removal of great saphenous vein.

The risk of the recurrence is the same , usually 3-5%, after a laser and traditional treatment.

EVLT has been widely examined and the observations have been done for more than 10 years.

The anesthesia which is used for this type of an intervention is called a tumescent anesthesia (from a latin: tumescere: to swell). It is a type of a local anesthesia but with a big amount of a reduced concentration of an anesthetic agent. This is a best type of anesthesia for this type of intervention, because it also helps to contract the vein and also picks up the energy from the around tissue.

In contrast to a classical operation EVLT method is much less invasive. After 1-2 hours of observation , the patient can return home.

After the treatment the special stockings with compression are recommended to be worn for 21 days

HYBRID OPERATIONS

Nowadays, both EVLT and Clarivein treatment, we join with a local miniphlebectomy and sclerotherapy in order to exclude not only the main venous trunk but also smaller branches, which give varicose veins in the area of knee or calf.

It improves the aesthetic result and and shortens the period of varicose vein closure. Sometimes, in some difficult cases with extensive varicose veins, the additional sclerotherapies are needed after 4-6 weeks.

CLARIVEIN: Mechanico-chemical ablation of veins

Clarivein is an alternative system to the thermal ablation of veins. In contrast to EVLT, as mentioned above, tumescent anesthesia, is not needed.

There is only a point local anesthesia iused at probe’s place of insertion into the vein. The energy is not necessary for this treatment (MOCA- mechanic-chemical ablation). In some cases it is better to use this method for ablation of a small saphenous vein.

Except from a special rotator, 2% aetoxysclerol is used for Clarivein intervention and the effect of this treatment is more durable than sclerotherapy itself. After 1-2 hours of observation, a patient can return home. After the treatment the special stockings with compression are recommended to be worn for 21 days.

Sclerotherapy under Doppler ultrasound control

Sclerotherapy under the control of Doppler is used to obliterate the bigger venous trunks. It helps to avoid surgery, sometimes it can be used instead of miniphlebectomy. During the treatment liquid or foam mixed with air are used in concentration from 1% to 3%.

The type of sclerotherapy under ultrasound control is the sclerotherapy with endovascular catheter, Doppler is used to illustrate the proper venous trunk. During sclerotherapy vein ( varicose vein) contracts and become fibrotic. Not only one sclerotherpy is needed to obliterate the vein, sometimes 2 or 3 sessions of treatment are necessary.

Side effects after sclerotherapy (they are sometimes present): irregularity or discoloration or hyperpigmantation of skin after obliteration of the vein, especially of a bigger caliber.

To avoid or to reduce the risk the mentioned side effects we recommend special stockings and local pads for compression, we suggest compression for 10-14 days depending on the place and extent of the treatment.

Sclerotherapy with illumination

This intervention is based on injections into small veins, teleangiectasia, small varicose veins. For this purpose the chemical substance polidocanol (aetoxysclerol) is used in various concentration from 0.5% to 2% of liquid or foam mixed with air in order to contract the vessel and then to fibrosis. This intervention is repeated, done in sessions usually every one month. For injections of the vessels the special kind of spotlight is used called illuminator to illustrate them well.