At the beginning of this century, there was a revolution in the treatment of venous disease that cause large varicose veins. In 2002, an interventional radiologist named Robert Min and his team treated the valve insufficiency in the “Saphena Magna” vein for the first time with the “endovenous laser therapy” (EVLT) method. This method is based on the principle of closing the leaking vein using laser energy inside the body, rather than removing it by surgically pulling it out. There is no leakage into the varicose veins from the vein closed with the laser; this closed vein is also absorbed by the body over time.

Endovenous Laser Therapy (EVLT) consists of a power source and a fiberoptic catheter that will transmit the energy from this power source into the vessel to be intervened under ultrasound guidance. Transmitting the laser beam at the appropriate wavelength for the tissue to be intervened, at the appropriate power and in the appropriate time. It is a modern treatment option based on the shrinkage and closure of the vessel by creating damage to the inner wall of the vessel with the heat generated.

HOW TO MAKE EVLT

With local anesthesia and sedation, If the vein we intervene is the great saphenous vein, that is, the great superficial vein on the inner face of our leg, our laser catheter is advanced from a region below the knee to the region where our superficial vein flows into the main deep vein in the groin region. From here, it is pulled back 1-2 cm, which is the safe zone, and placed. If the vein to be intervened is the small saphenous vein, that is, the small superficial vein on our calf, on the back of the leg, the same procedures will be repeated, but this time the catheter will be placed in the appropriate place in the back of the knee, accompanied by ultrasonography. Following these procedures, that is, after the laser catheter is placed in the appropriate place, cold serum containing appropriate doses of adrenaline, bicarbonate, and local anesthetic, which we call tumescent anesthesia, will be injected under the outer sheath of the vessel through the catheter. The purpose of this liquid application

1. Increasing the effect of the laser by shrinking the vein with cold serum and at the same time protecting the surrounding tissue from the effects of the high heat generated by the laser.
2. To limit possible bleeding with adrenaline 
3. With local anesthetics, it is to ensure that you spend the hours following the surgery more painless and comfortably.

CANDIDATES FOR EVLT?

EVLT, Laser vein treatment, can be applied to patients with a vessel diameter greater than 5.5 mm as a result of Doppler ultrasonography and with 3 or 4 degree venous insufficiency. Another point that should not be forgotten is that EVLT treatment is guaranteed up to 12 mm in diameter as classical information. Although we can successfully close vessels with higher diameters with additional measures and techniques, it should be kept in mind that the safe range is 12 mm and it should not be delayed too long.

WHO CANNOT BE TREATED WİTH EVLT

• Those who are pregnant,
• Those with advanced arterial disease,
• Bedridden patients,
• Patients with poor general condition,
• Patients with a life expectancy of less than 6 months,
• Patients with bleeding tendency

It is not preferred to be applied, but the main topic that needs attention is the patients with deep vein thrombosis. Patients with a history of deep vein thrombosis, advanced venous insufficiency or even open wounds should be approached very carefully.

WHAT ARE THE SIDE EFFECTS OF EVLT?

Although it is very rare compared to open surgery, which is the old method, there are minor side effects in EVLT, as in every interventional procedure.

• Feeling of withdrawal: After the procedure, some of the patients will have a feeling of pulling along the vein trace, which is burned with laser, and this will disappear within a few months when the leg and that area regain their elasticity.
• Neurological complaints: Some of our patients may have symptoms such as numbness, electrification shock, hypoesthesia, or hyperesthesia. Since the vascular nerve bundle in our arms and legs is adjacent to each other, minor damage to our sensory nerves due to the thermal injury of the laser may cause these complaints. It will disappear on its own within 3 to 6 months. Only patients with very advanced complaints can be supplemented with vitamin B.
• Phlebitis: Redness, tenderness, pain and temperature increase in the treated area can be seen in rare cases. It heals within a week with cold dressing, painkillers and antibiotics.
• Bruising: Although rarely, bruises may occur in the treatment area along the vein. As with any bruise, it heals spontaneously within 1-2 weeks.
• Deep vein thrombosis and pulmonary embolism: DVT and PE, a rare but feared complication after EVLT, can be life-threatening. Early mobilization anticoagulation and compression stockings are the best ways to protect themselves.
• Skin burns: Although it is a rare complication after EVLT, it is an annoying complication because it will not go away and will leave a scar. It can be easily avoided with a good tumescent anesthesia application and the use of high quality lasers.

WHEN CAN I RETURN TO MY NORMAL LIFE?

The pain and complication rate of EVLT itself is extremely low. The main cause of pain in patients who have surgery is the process of removing the vessels that are cosmetically disturbing to you through the small holes we call miniphlebectomy. Yes, these areas will be painful. And the complaints that bother you after the surgery will originate from these areas. However, you will have a very comfortable period after EVLT. Your hospital discharge will be with elastic bandages. The next morning, after removing your elastic bandage and showering, I will ask you to wear compression stockings for 20 days. Since early mobilization, absence of pain and bleeding are among the biggest advantages of this treatment, you can go to work even the next morning if you wish. We can operate on Friday evenings or Saturdays, for our patients who cannot take working leave, and then send them to their workplaces very comfortably on Monday. So you have no restrictions.

WHAT IS THE SUCCESS OF EVLT TREATMENT?

EVLT treatment is the most applied and most successful treatment method in the world for the last 15 years. Success rates between 94% and 98.5% are reported in the results published from different centers. With increasing experience and developing technology, success rates are increasing gradually.

WHAT ARE THE ADVANTAGES OF EVLT TREATMENT?

In addition to its many advantages, the prominent advantages of EVLT treatment are:

• No need for general anesthesia
• No pain
• No bleeding
• No bruising
• No scars
• The procedure is around 30-90 minutes depending on the number of veins to be intervened associated miniphlebectomy
• There is almost no risk of infection.

I NEED THIS VESSEL

Since there is an average of 100,00-150,000 km of vessels in our body, closing a diseased vessel will not do you any harm. The circulation will be diverted to new pathways outside the closed vessel, and even if there is a temporary edema, this will resolve itself within a few weeks. One of the most frequently asked questions in this topic is that this vein should be saved for a future coronary bypass surgery, which is why we do not use sick veins for this purpose, so you don't need this vein.

CAN EVLT BE APPLIED IN THE SAME SESSION FOR BOTH 2 LEGS?

Since the patients remained immobile after classical, that is, open surgeries, and the risk of deep vein thrombosis and pulmonary embolism increased, it was not preferred to perform open surgeries on both legs. However, since early mobilization is possible with the EVLT method, both legs can be operated easily and there will be no problems.

HOW TO PREPARE FOR EVLT

There is no significant preparation before EVLT. As with any patient entering the operating room, an anesthetic examination and a small blood test panel are required. Apart from this, the most important point to be considered is hunger and thirst for 8 hours, as in every patient, before entering the operating room. For male patients, it is also necessary to shave from the navel region down.

WHAT IS THE RECURRENCE RATE AFTER EVLT?

After EVLT treatment, which has a success rate of over 94% and 98,5%, recurrence is almost non-existent with the developing technology and our increasing experience. Recurrence is actually very rare in venous diseases. However, due to your genetic predisposition, our blood vessels that are healthy today are more likely to get sick over time.

DO SPECIAL INSURANCES PROTECT EVLT TREATMENT?

Since EVLT treatment is classified as inpatient treatment in the guidelines, YES is fully covered by private insurances.

WHEN I SHOULD CALL MY DOCTOR AFTER EVLT?

Although EVLT is a very successful treatment method with a very low complication rate, although there is a rare risk of deep vein thrombosis, when there is an unexpected redness, increase in temperature, tenderness or sudden swelling in the leg, an exaggerated pain, a feeling of tension or when you have shortness of breath, you should contact your doctor immediately.

WHAT SHOULD I DO WHEN I COME HOME AFTER TREATMENT

Like the EVLT treatment itself, the post-operative period will be very comfortable and enjoyable. You can continue your normal life without any restrictions. I recommend antibiotics and anti-inflammatory for 3 days. Apart from this, you will use compression stockings for 20 days.

HOW MANY DAYS DO I HAVE TO STAY IN HOSPITAL AFTER EVLT

Unlike classical, open surgery, EVLT treatment is an outpatient treatment. There is no hospitalization. The total time you will spend in the hospital will be around 5-6 hours, after this operation we performed with local anesthesia and sedation, you will be at home within 2-3 hours after the operation.