What is Endovenous Laser Treatment (EVLT)?

I think it's helpful to think of veins like a Christmas tree. You have a main vein that runs up the centre of your leg and you've loads and loads of branches coming in. They can number hundreds.

A varicose vein is one of the smaller veins that's draining your skin and it normally runs from your groin right the way down to your knee. Endovenous laser treatment is where I thread a small laser up the inside of that vein and essentially deliver heat, and that heat destroys the vein.

Is EVLT safe?

EVLT is a very safe and effective treatment. It has really superseded the older operation of stripping. We can do it for the most part, under local anaesthetic. Patients walk in and walk out - and that significantly reduces the risk of complications.

Are my varicose veins suitable for EVLT?

Most people are suitable for Endovenous laser treatment. Occasionally people are unsuitable when they've had multiple previous operations, for example, stripping. But in my practice, approximately 95% of people are offered Endovenous laser treatment.

What happens during Endovenous Laser Treatment for varicose veins?

We always perform Endovenous laser treatment in a sterile operating theatre. You would come into that theatre, lie on an operating bed and, after a few moments, I would inject some local anaesthetic in your leg. Subsequently, I thread the small laser up the inside of your vein. And that whole procedure takes somewhere between 15 and 20 minutes.

Once it's finished, I would place you in a bandage. That bandage is non-sticky and can be removed very, very easily. And I use it instead of using an uncomfortable compression stocking.

Is the EVLT procedure painful?

EVLT in itself is not painful, but I have to give some local anaesthetic in order to make that happen. It usually involves some small injections of local anaesthetic on the inside of your thigh. I think most people think of that as similar to a trip to the dentist.

What should I expect after EVLT?

Well, most people following the procedure are relieved that it wasn't as bad as they thought it was going to be. They normally walk outside and are completely pain free. However, the next day it does feel like you've pulled a muscle. Most people can walk around the house with ease or could walk the dog or even walk their kids to school.

I usually suggest that they take a painkiller of some sort and that normally allows full movement. However, it does feel a little uncomfortable and I think it takes about two weeks before you forget that I've done your operation.

How long will I need to be off work after EVLT?

In terms of taking time off work following Endovenous laser treatment, I think most people could work from home the following day, but it does feel uncomfortable - rather like a pulled muscle. So, if you have a long commute, many people take a little longer than that off.

How long after EVLT will I see results?

Following Endovenous laser treatment, you will normally see results very quickly. Any symptoms you had before the procedure usually subside really quickly. I think it takes between two and three weeks for discomfort to disappear. But I think it takes between six and eight weeks for them to appear cosmetically ok.

Will I need a follow-up after Endovenous Laser Treatment?

Most people do not require a follow up post EVLT. I'm very careful about asking you why you're having your vein operation. And I'm very clear about what your outcome will be. In general, it takes about six weeks to get the full effect following Endovenous Laser Treatment. And usually, people are pain free or symptom free and don't usually require a long trip back to see me again.

When can I go to the gym and start exercising after EVLT?

With regards to exercise and attending the gym following Endovenous laser treatment, most people can, for example, walk the dog the following day. But I think it takes a little longer before you can do any energetic exercise. Most people will play golf after a week or so. But running and cycling normally takes about two weeks.

How soon after EVLT can I fly?

You can fly whenever you like following EVLT. However, I do think it's a little uncomfortable, so I wouldn't fly for the first week or so. People are sometimes worried that flying is associated with deep vein thrombosis, but that is not really the case.

Will my varicose veins come back after EVLT?

It is very unlikely that your varicose veins will come back following Endovenous laser treatment. Once I treat the vein with the laser, it essentially has disappeared. However, people sometimes want to know how likely they are to come back at any stage with another varicose vein.

The answer to that is for about 10% of people, it will come back at some stage in the rest of their life with another vein. It's nearly always on the other leg.

In a healthy vein, blood will flow smoothly to the heart and is prevented from flowing backwards by a series of tiny valves. Sometimes these valves will weaken or become damaged, allowing blood to flow backwards and collect in the vein. When this happens, the vein can become swollen and enlarged - causing varicose veins to form.

EVLT is a minimally-invasive laser treatment for painful or unsightly varicose veins. The treatment typically takes about 30-40 minutes, quickly removing varicose veins while minimising pain and recovery time.

EVLT was recommended as the preferred surgical option for varicose veins by the National Institute for Health and Care Excellence (NICE) in 2013. The complication rates are the lower than for the old style ‘high tie and strip’ operation. We’ll make sure that all safety precautions are taken during the operation, including asking you to wear special glasses while your Consultant uses the laser.

Approximately 85% of people with varicose veins are suitable for EVLT, but your Consultant will discuss your suitability with you after assessing and scanning your varicose veins.

Using ultrasound, your Consultant will position an EVLT laser fibre into the diseased vein via a small hole in your skin. The heat generated causes the vein to close and blood is prevented from flowing through the vein which shrinks and fades; your body absorbs it and it disappears naturally.

After treatment, you should wear your bandages for five days before soaking them off in the bath. You can then wear a compression stocking which you should keep on for two weeks.

Studies suggest the average time off work after EVLT is three days, compared with 12 days after open varicose vein surgery. You should have recovered enough to drive a car after five days.

By two weeks after surgery, most patients are back to light exercise.

If, after six weeks, there are still small veins left in your calf, they can be removed by injecting them with a chemical in our outpatients department to improve the appearance of your leg. This is known as sclerotherapy.

Long haul flights (more than four hours) should ideally be avoided for four weeks after surgery.

This used to be very common with the old ‘high tie and strip’ operation, where up to 30% of patients would get a significant recurrence after surgery.

Nowadays, after laser surgery, the risk of a recurrence is about one percent. However, there is about a ten percent chance of another vein on that leg - or the other leg - becoming varicosed over the following decades. But, for most people, EVLT resolves any problems with varicose veins.

Self-paying patients

If you need treatment, but don’t want to wait, you can access EVLT quickly as a self-pay patient without needing a GP referral. Make an appointment by completing our online form or by calling our Private Patient Team on 01580 363158.

Benenden Health members

If you’re a member of Benenden Health, please contact their Member services team on 0800 414 8100 to discuss your treatment. You’ll need a referral from your GP.

NHS patients

You should arrange to see your GP for a referral letter.