Whenever we come across the word “laser” – and in medicine would not be less – it seems to have a magical, striking effect. Some mysterious halo surrounds this word, which seems to promise that it is able to solve anything, whatever it might be… Beyond any doubt, this is one of the reasons for the great success of these techniques during the last few years.
Both techniques (laser and radiofrequency) are able to treat the varicose veins by “endovenous thermal ablation”.
The term “ablation” in medicine usually refers to “removal or separation”, although it is not exactly what we are meaning here. In this case ablation rather refers to “definite occlusion” of a vein (made on purpose). The term “endovenous” means that it is performed from inside the vein itself, and “thermal” because we get the result by delivering heat.
Both techniques (laser and radiofrequency) are extremely similar, and generally speaking, we use them only to treat the great saphenous vein, and exclusively on its segment along the thigh – from the groin to the knee (there are exceptions to this, but for now they are just exceptions). The procedure involves inserting a catheter (a long, thin plastic tube) into the vein through a puncture or small incision either at the ankle or knee level; we bring it up inside the vein until shortly before the great saphenous vein joins the common femoral vein (the saphenofemoral junction, which is the place where the problem most frequently has begun); and through the catheter tip we deliver heat, so that we “burn” (in a controlled manner, of course) the vein from inside, causing it to shrink and close. As we are removing the catheter down we are “sealing” the vein from inside. The only difference between both techniques is whether the source of the heat delivered to the vein is laser (light energy) or radiofrequency (electromagnetic energy).
The procedure can be performed under local anesthesia in most cases, if necessary accompanied by some superficial sedation. This anesthesia is applied diluted in some amount of liquid, and we infuse it around the entire vein to act at the same time as “cushion”, absorbing excess of heat and thus preventing thermal damage to a neighbouring structure. It is an outpatient procedure, so after one hour the patient is already walking (wearing the usual compression stocking) and can go home without the need for hospital admission.
Although these techniques still have not been followed up for as long as the classic surgery, we are having more and more studies available about them, and also these studies are better designed and of better quality. The results derived from these studies show that, if we select the cases well (it means, if we apply these techniques only in the ideal patients), the results are at least as good as the stripping but less aggressive and with a much faster recovery, which is a clear advantage over classic stripping.
However, not all varicose veins (and not all the patients) can be treated using these techniques (I mentioned before that, as a general rule, they can only be used to treat the greater saphenous vein from the groin to the knee). As always, the vascular surgeon is the appropriate person to recommend the best option for a given individual (customize the treatment), once the necessary examinations have been carried out.
Below, the official video from Covidien® (the company manufacturing the radiofrequency device), to illustrate the procedure:
And similarly, an animation summarizing the treatment with laser (or EVLT®), published by the clinic VenaCare®:
Finally, a video explaining a REAL laser procedure, and a demonstration of the way it works (using a real vein already excised from the body, to be able to see it clearly), published by Dr. Robson de Miranda (Fluox® clinic). The comments are in Portuguese from Brazil, but I hope that with the explanations given above in the post, it can be easily understood. Also, I insist that the images are real, and can be disgusting for some sensible persons:
If you are interested in further knowledge about this disease, its causes, consequences, how it can be treated and, even better, how are we able to prevent it, you have everything explained in a very friendly and easy way in the book VARICOSE VEINS: truth & myths.