Endovenous Laser Therapy (ELT)
Endovenous laser treatment, or therapy (ELT) is a minimally invasive ultrasound-guided technique used for treating varicose veins using laser energy commonly performed by a phlebologist, interventional radiologist or vascular surgeon.
Endovenous laser treatment treats varicose veins using an optical fiber that is inserted into the vein to be treated, and laser light, normally in the infrared portion of the spectrum, shines into the interior of the vein. This causes the vein to contract, and the optical fiber is slowly withdrawn. Some minor complications can occur, including thrombophlebitis, pain, hematoma, edema and infection, which can lead to cellulitis. The treatment was originally pioneered by Dr. Robert Min of New York, USA, using a wavelength of 810nm. Since then, however, the preferred wavelength has gradually got longer, and now 1470nm or 1550nm is preferred, the basic aim being to maximize local damage to a component of the varicose vein or the blood contained in it while minimizing damage to adjacent tissues. During the procedure, a catheter bearing the laser fiber is inserted under ultrasound guidance into the great saphenous vein (GSV) or small saphenous vein (SSV) through a small puncture. The catheter is then advanced, also under ultrasound guidance, to the level of the groin or knee crease. Dilute local anesthesia is injected around and along the vein (perivascular infiltration) using ultrasound imaging to place the local anesthetic solution around the vein, mostly in a sub-facial location. This technique derives from the tumescent local anesthesia (TLA) method long used and proven safe and effective for some methods of liposuction. The laser is activated whilst the catheter or laser fiber is slowly withdrawn, resulting in obliteration of the saphenous vein along its entire length. The treatment, which is performed without sedation, now usually takes less than 1 hour, and the patient walks out under his or her own power. The leg is bandaged and/or placed in a stocking that the patient wears for up to three weeks afterwards. Foam sclerotherapy or ambulatory phlebectomy is often performed at the time of the procedure or within the first 1–2 weeks to treat branch varicose veins. However, some physicians do not perform these procedures at the time of the ELT because the varicose veins can improve on their own as a result of reduced reflux from the great saphenous vein.
Because it operates at 1550nm and has an output power of up to 15W, the DIOMAX 1550 Diode Laser System, used in conjunction with VENEX Sphere or VENEX 360 Fibres, is an ideal system for ELT procedures.
