EndoVenous Laser Therapy (EVLT) Information Booklet. Dr. Dueck. Varicose Veins

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1 EndoVenous Laser Therapy (EVLT) Information Booklet Dr. Dueck Varicose Veins Varicose veins are abnormally large veins that protrude from under the skin in the legs. They can be associated with a brown discolouration (staining) or small purple or dark blue veins (reticular or spider veins). In addition to these visual changes, varicose veins can cause symptoms of discomfort, aching, mild swelling, burning, itching or fatigue. Venous Valves and reflux All veins in the legs have thin valves that help direct blood flow toward the heart. These valves prevent blood from rushing backwards toward the ankles, especially when standing up. Varicose veins are branches of one of two main superficial veins called the greater (long) or lesser (short) saphenous vein. Varicose veins usually result because of a failure of the valves in the greater saphenous vein which runs down the inside of the leg, right from the top of the leg down to the ankle. Even though symptoms and visible changes are most often seen below the knee, the portion of vein that is usually responsible is in the upper part of the leg, from the top of the leg to the knee. These superficial veins are extra veins, and can be removed or ablated without harm to your health or circulation. Occasionally deep veins can be responsible for some or all of the symptoms you may be having. Deep veins are close to the bone and can only be seen by ultrasound, although they can contribute to varicose veins you can see by individual connecting veins called perforating veins. Deep veins are very important veins that cannot be removed; they are critical to normal circulation in your legs. Dr. Dueck will assess both your superficial and deep veins to help determine the best treatment for you, and what to expect from treatment in terms of symptom relief. Laser Treatment (EVLT) EndoVenous Laser Therapy (EVLT) is a minimally invasive way to ablate a saphenous vein with valves that are not working, which is the cause of varicose veins. Local anesthetic is used to freeze the skin and the area around the veins between the knee and the top of the leg. The laser is then used to fuse the vein shut. The procedure takes approximately 45 minutes. Bruising along the course of the vein is expected, but the amount of bruising and also the degree of discomfort is far less than after surgical stripping. Other advantages of EVLT is that a general anaesthetic is not required, return to regular activities is much faster, and rather than surgical scars there is only one 2 3mm mark in the skin where the needle enters. Following EVLT visible varicosities often disappear, depending on their size and location. Regardless of the appearance of varicosities, symptoms are very likely to improve significantly or resolve entirely following the procedure (if the deep veins are normal). Sometimes large varicosities, or those fed by perforating veins can be persistent after

2 laser treatment. In these cases Dr. Dueck will remove them under local anaesthetic a few months after your laser treatment. Finally, very small surface veins called spider veins do not typically resolve and usually require injection treatments after laser therapy. Any discolouration in the skin present before the procedure, especially if brown, is permanent and will not change as a result of EVLT or surgical therapy. In a minority of cases, after the procedure a small brownish bruise can form over resolving veins. These bruises are temporary but can take a long time to resolve (sometime more than a year). Costs of Laser Treatment (EVLT) EndoVenous Laser Therapy (EVLT) is not covered by OHIP or other provincial health insurance plans. The cost of the procedure is $3, per leg. A pair of compression stockings is also required. These are not covered by OHIP, however the vast majority of private insurance plans cover 23 pairs per year. For your convenience these can be purchased through the office at a cost of $ plus GST. You will be issued a separate receipt for these that you can remit to your insurance provider for reimbursement.

3 Preparing for your EVLT procedure: A few days before You must have your prescription filled for your compression stockings (30 40mmHg thigh high compression), or have ordered the stockings through Dr. Dueck s office. The night before You must have your prescription filled for your compression stockings (30 40mmHg thigh high compression), or have ordered the stockings through Dr. Dueck s office. Drink plenty of water the night before the procedure Relax! Morning of procedure You may have a light breakfast. We encourage you to drink fluids (water, juice, etc.), however avoid beverages containing caffeine (e.g. coffee, tea, cola, etc.). Wear comfortable, loose fitting clothing Bring your compression stockings (3040mmHg thigh high compression) with you to Dr. Dueck s office; you do not need to do this if you have ordered the compression stockings through Dr. Dueck s office. We advise you have someone with you who can drive you home after the procedure.

4 The EVLT Procedure When you arrive you will check in, then get changed into a gown. You may leave your shirt/sweater and underwear on. Dr. Dueck will visit you and review the details of your procedure and you will be given a chance to ask any additional questions. Dr. Dueck will go through the consent process with you. Dr. Dueck will then ultrasound your leg while you are standing and a (washable) marker will be used to mark the portion of the leg where the freezing and needle will go in. You will be asked to walk around for a few minutes, then lie down on the stretcher A washable, orange cleaning solution will be applied to your leg. After injecting some freezing, the laser fiber will be advanced into the vein. Dr. Dueck will freeze along the vein using multiple injections with a very thin needle. The laser will be turned on and the vein ablated. The fiber will be removed, the leg cleaned of the orange prep solution, and we will help you apply the stocking.

5 Following the EVLT Procedure For the first 48 hours after the procedure: Continue to wear the compression stocking on the treated leg. Do not remove the compression stocking at night or to shower. Removing the compression stocking early is not dangerous to your health, however if you do so the vein that was treated by laser could reopen and you would then require a second procedure. We encourage you to walk around regularly as this will promote blood flow in your deep veins and reduce the chance of a blood clot even further You can expect to have some bruising along the thigh, as well as mild swelling. Along the inside of the thigh you may feel a cord like thickening (which is the treated vein). All of these symptoms are temporary and will resolve over time. The bruising typically lasts for a few weeks, while the thickened vein may take several months before it is completely soft again. You may have mild discomfort in the first day or two. We recommend you take one tablet of Advil in the morning and another in the evening every day for 5 days following the procedure, even if you don t have pain. This helps prevent inflammation from developing. If you can t take Advil, speak to Dr. Dueck regarding alternatives. 48 hours after the procedure (i.e. Sunday if you had your procedure on Friday): You can remove your compression stocking, have a shower or bath, and then put your compression stocking back on. You should wear the compression stocking every day until 1 month following the procedure. You do not have to wear the stockings overnight. In the morning, put the stocking on as you are getting dressed, then remove it at night before you go to bed. 48h 1 month after the procedure Wear the compression stocking every day until 1 month following the procedure. You do not have to wear the stockings overnight. In the morning, put the stocking on as you are getting dressed, then remove it at night just before you go to bed. 1 month after the procedure At the time of your procedure, you will be given a followup appointment to see Dr. Dueck in the office. After 1 month you no longer need to wear your compression stockings (unless Dr. Dueck has specifically instructed you to do so). Dr. Dueck will examine your leg and determine if any further treatment is required

6 Exercise after the EVLT procedure: For the first 48 hours following the procedure: We encourage you to walk. It s best to walk around at least every few hours during the day while you are awake. You do NOT need to wake yourself up at night to walk. For 48h 2 weeks following the procedure: Light exercise such as long walks and gentle upper body exercises are encouraged. Always wear your compression stockings while exercising. For 2 4 weeks following the procedure: Moderate exercise such as jogging, yoga or gentle weights are safe. Always wear your compression stockings while exercising (even if you are only doing weight training). After 1 month: You can return to all normal exercise without limitations. You no longer need to wear the compression stocking while exercising unless Dr. Dueck specifically instructed you to do so. What should I do if I have concerns after the EVLT procedure? If you have a concern after the EVLT procedure you can contact our office by telephone ( ) or (margaret.robertson@sunnybrook.ca). If you have a concern and feel you need to be assessed after hours or on the weekend, please go to the Sunnybrook Hospital Emergency Room and instruct the staff you are here to see Dr. Dueck.

7 EVLT Deposit Invoice Name Date of Deposit / / Date of Procedure Deposit amount: $ Paid by VISA/MC Cheque Deposit terms: If you cannot attend your procedure date, please let our office know as soon as possible. Because a time has been reserved specifically for you, late cancellations will result in a penalty as outlined below: Cancellation >7 days before procedure Cancellation within 7 days Cancellation within 48h Refund full deposit $ penalty ($ refunded) $ penalty ($ refunded) I understand and agree to the terms listed above, X Print Name: Date:

8 EVLT Procedure Invoice Name: Date: EVLT Procedure Fee (per leg) Less Deposit Total: $ ($ ) $ Paid: VISA/MC Cheque Cash