Endovenous Treatment Options

What does endovenous mean? Endovenous is a medical term that means within or inside a vein. Endovenous treatments can be divided into two categories:

1. Thermal treatments that use laser energy or radio frequency waves to treat the vein and tumescent anesthesia to protect tissues surrounding the vein during the procedure.

2. Non-thermal, non-tumescent (NTNT) treatments, which are procedures that do not require the use of heat or tumescent anesthesia.

In this post, we’ll look at thermal endovenous treatments include endovenous laser ablation (EVLA), also called endovenous laser therapy (EVLT™) and radio frequency ablation (RFA). These are minimally invasive treatments used to address specific large varicose veins in the legs. It is considered the gold standard in treatment of named veins, such as the great and small saphenous veins. It has largely replaced previous, more invasive standards of care, such as vein stripping.

Endothermal ablation has opened the door for many patients with venous disorders to eliminate symptoms and improve their appearance with minimal time investment or pain. Endothermal ablation is an outpatient procedure performed with local anesthetic.

The procedure begins when the provider places a tiny access port directly into the problematic vein. Don’t worry, before the placement, we numb the skin with a small amount of local anesthetic. Once access is established, a very thin laser fiber is threaded into the vein up to the place “where health meets disease,” as Dr. Asbjornsen likes to say!

Patients can't feel the laser fiber because the inner walls of the veins do not have sensor receptors. Once in position, more numbing medicine is added to the outside of the vein; it should not be more uncomfortable than the first pinch when access was established.

Once the leg is numb, the heat source is turned on or "fired," sealing the vein shut from the inside out. The vein eventually is reabsorbed by the body and will no longer be visible on the surface of the leg. Blood is diverted to the many other healthy veins in the leg, and there is no ill effect from the loss of the troublesome vein. Patients can return to work the next day with very limited restrictions.

What is Tumescent Anesthesia?


The thermal endovenous treatments involve tumescent anesthesia, a technique in which a high volume of a dilute local anesthetic is infiltrated around the vein. Tumescent anesthesia serves three purposes during thermal ablation:

1. The fluid is an anesthetic, keeping the patient comfortable during the procedure.

2. It creates an insulating ring around the vein and thermal energy source. This protects all surrounding tissues, including nerves and muscles, thus stopping any type of collateral damage.

3. It causes the vein walls to collapse around the thermal fiber, maximizing contact and increasing the effectiveness of the procedure.

The tumescent fluid can be administered in many ways, but with a trained and proficient physician, the process is comfortable and painless.

To learn more about vein treatments options, contact us at the Vein Healthcare Center today to schedule an evaluation!