Monday, May 19, 2014

After EVLA

As with any medical procedure, if you’ve undergone Endovenous Laser Ablation Therapy, or EVLA, it is important to know what to expect after the procedure— and to understand any recommendations or restrictions the doctor gives you.

Because EVLA is minimally invasive and almost always performed in an outpatient setting, there is usually minimal down time, if any. In most cases, those who undergo EVLA treatment can return to their regular daily activities immediately. In fact, many patients may return to work the day after your appointment, provided the job is not physically strenuous.

Immediately after the EVLA is performed, your leg will be washed and you will be asked to put on your compression stockings. Compression stockings should be worn for the first two weeks following treatment any time you are on your feet. (They do not need to be worn during sleep.) This is an important requirement and can make a big difference in your recovery.

Following EVLA, the treated leg may drain fluid for the first 24 hours, making the compression stocking feel damp. Patients can expect a moderate amount of bruising, swelling, and discomfort. Post-procedure discomfort is highly variable from patient to patient, and while some patients may experience pain, some may feel no discomfort at all following the procedure. Elevating your legs as much as possible, applying heat, and taking ibuprofen as needed are all effective ways to ease most post-operative pain.

Another important recommendation is to walk for 30 minutes each day for the first two weeks after your procedure. Walking can be done in short increments throughout the day adding up to 30 minutes, or it can be done all at once, whatever works best for your schedule.

Post-procedure restrictions include no heavy lifting and no strenuous physical activity while standing. However, patients should feel free to exercise as long as their feet remain at, or above, the level of their heart (e.g. swimming or floor exercises, ideally with feet on an exercise ball).

The main reason for these restrictions is that those activities increase pressure by tightening the core or abdominal muscles— which then increases pressure downward into the legs. That pressure can cause irritation of the treated vein, which may lead to swelling. It's possile that the swelling could develop into phleblitis. The closed vein likely won’t open, but phlebitis can be quite uncomfortable.

Hot tubs are also restricted while you are healing. Even though doctors sometimes suggest patients use heating pads post-procedure, in a hot tub all of the veins in the legs above and below the treated area become dilated. This can actually cause pain.
Follow up
Finally, and most importantly: schedule a follow-up visit to the phlebologist within a week following the procedure to ensure that everything is healing properly. 

Tuesday, May 6, 2014

What can you expect at an EVLA appointment?

So you’ve met with a board certified vein specialist and learned about EVLA, made an appointment, and prepared for the procedure. What’s next? 

When you arrive for your EVLA appointment, you will change into exam shorts and photos of your leg will be taken. (Photos are used for your personal medical chart, in order to track improvement and recovery.) Your leg will be re-checked using ultrasound, and your doctor will write on your leg with a magic marker. Your vital signs will be checked, and you'll be asked to relax on a procedure table. There are often pillows and blankets available for your comfort, and if you bring a listening device, you can begin listening to music.

Your leg will be cleansed with an iodine solution to the groin— you should make the physician aware of any iodine or seafood allergies you may have. An IV will be placed in the problematic vein, usually at or around the level of your knee, or in the middle section of the back of your calf. You will feel a small pinch of local anesthetic during this part of the procedure.

Under ultrasound guidance, a laser fiber will then be threaded up to the highest point of venous insufficiency. There should be little or no discomfort. The area to be treated will then be fully anesthetized. Most physicians ask their patients to wear special safety glasses to protect eyes from the laser. The laser will then be turned on, and the ablation of the vein will begin, a process that usually takes approximately forty minutes.

The physician should provide you with post-operative requirements. Following guidelines for care after your treatment will help promote the most effective healing so you can return to your daily routine and start experiencing a comfortable, symptom-free life as soon as possible.