Procedure: Endovenous laser ablation of Right GSV and SSV left great and left small saphenous veins       Â
Indication: Long-standing venous insufficiency with failed medical therapy Â
Date:
Operators: John Doe, MD (Attending)/Jane Doe, MD (Fellow) Â Â
Site: Left great saphenous and left small saphenous veins
Treatment length: GSV 55 cm .  Power Setting: 8 Watts. Energy: 4449 Joules; [ ] sec
Treatment length: SSV 23 cm .   Power Setting: 8 Watts. Energy: 2841 Joules time [ ] sec
Complications:Â None immediate.
Procedure and technique:
The risks, benefits, and alternatives to the procedure were explained to the patient. The specific risks of bleeding, PAIN; infection, DVT, and nerve injury were discussed and accepted. Written informed consent was obtained. A time out/call to order was performed prior to procedure initiation.
The patient ambulated for [0] minutes prior to venipuncture.
The patient was placed SUPINE OR PRONE on the treatment table, and the lower extremity prepped and draped in sterile fashion from the ankle to the groin .Â
Using ultrasound guidance, the GSV AND SSV saphenous vein was punctured antegrade mid Calf areas using 21-gauge needles. A 0.018″ wire was placed, and the needle exchanged for a transitional dilator.Â
A 0.035″ guidewire was advanced through the transitional dilator centrally. The dilator was exchanged for the laser sheath. The laser fiber was placed through the sheath and the sheath tip location was ultrasonographically confirmed to lie within the GSV vein, and SSV approximately 3 cm from the confluence with the Deep veins. The SSV had an above knee superficial extension after the main trunk joined the popliteal above knee.
Tumescent anesthesia (buffered dilute lidocaine) was injected along the entire course of the treated segments of the veins utilizing a motor operated pump. Â
Utilizing 8 Watts power at 50 t0 100 Joules / Cm. as noted above, The lasers were removed and Steri-Strips applied.
The sites were sterilely dressed. Compression stockings were placed on the treated limb immediately post-procedure. Â
Instructions:Â
- The patient was instructed to wear the compression hose continuously for 24 hours and then during all waking hours for an additional 3 weeks.Â
- No strenuous activity/exercise for one week.Â
- No jacuzzi, sauna or heating pad for 3 months.
- NSAID for 1 week with food
Follow-up was scheduled for call on Monday and vein perforator vein treatments in 2 weeks..
Impression: Â Uneventful laser ablation of the RG and RS saphenous veins as described above.Â
Frequently Asked Questions
What is endovenous laser ablation for varicose veins?
Endovenous laser ablation (EVLA) is a minimally invasive procedure used to treat varicose veins, particularly in the great saphenous vein (GSV) and small saphenous vein (SSV). It involves inserting a laser fiber into the affected vein, which emits energy to seal the vein shut, redirecting blood flow to healthier veins. This technique reduces symptoms of venous insufficiency such as swelling, pain, and heaviness in the legs.
Laser ablation is performed using ultrasound guidance to accurately insert a laser fiber into the saphenous veins. The procedure begins by puncturing the vein with a needle and threading a guidewire and sheath into it. Tumescent anesthesia is then applied, and the laser fiber is activated to deliver energy, closing the vein. The process is relatively quick and concluded with applying compression stockings to aid recovery.
What are the risks associated with laser ablation of veins?
While generally safe, laser ablation carries some risks, including bleeding, pain, infection, deep vein thrombosis (DVT), and nerve injury. These risks are minimized by using ultrasound guidance and providing comprehensive patient consent and education. Patients are monitored closely during and after the procedure to ensure any complications are promptly addressed.
What should you expect after a laser vein ablation procedure?
After laser ablation, patients can expect minor bruising and soreness in the treated area. Compression stockings are worn continuously for 24 hours and then during waking hours for three weeks. Strenuous activities should be avoided for one week, and exposure to heat sources like jacuzzis and saunas should be avoided for three months. NSAIDs can help manage any discomfort.
Why is tumescent anesthesia used in laser vein ablation?
Tumescent anesthesia, which involves the injection of a diluted local anesthetic like lidocaine, is used to numb the area around the veins being treated. It helps minimize pain during the procedure, reduces the risk of thermal injury to surrounding tissues, and compresses veins for better contact with the laser fiber, enhancing the procedure's effectiveness.
How long does recovery take after laser ablation of veins?
Recovery from laser ablation is typically quick, with most patients returning to normal activities within a few days. Full recovery and the resolution of symptoms like leg swelling and pain may take a few weeks. Follow-up care includes wearing compression stockings and attending scheduled appointments to monitor healing and address any issues.
What is the role of compression stockings post-laser ablation?
Compression stockings play a crucial role in recovery after laser ablation. They help reduce swelling, support vein closure, and improve blood flow in the legs. Patients are advised to wear them continuously for the first 24 hours and then during waking hours for about three weeks to ensure optimal healing and vein function.