Endovenous Laser Ablation (EVLA): How It Works
Endovenous Laser Ablation (EVLA) is one of the most commonly performed treatments for varicose veins worldwide. It is a minimally invasive procedure that treats the underlying cause of varicose veins by closing the faulty vein from the inside, allowing blood to flow through healthy veins instead.
Illustration for educational purposes. Not to scale.
Unlike traditional vein stripping surgery, EVLA does not require large incisions or removal of the vein. It is usually performed as a day procedure under local anaesthesia, allowing most patients to return home shortly afterwards.
During EVLA, a fine laser fibre is inserted into the diseased vein under ultrasound guidance through a small needle puncture. A dilute local anaesthetic solution, known as tumescent anaesthesia, is then injected around the vein. This serves several important purposes: it numbs the area to maximise comfort, protects the surrounding tissues from heat, and compresses the vein around the laser fibre, improving treatment effectiveness.
Laser energy is then delivered as the fibre is slowly withdrawn along the vein. The heat causes the vein wall to collapse and seal permanently. Over the following months, the treated vein is gradually broken down and absorbed naturally by the body. Blood is immediately redirected into the healthy deep veins, which carry approximately 90% of the blood returning from the leg, so closing the diseased superficial vein does not impair circulation.
The procedure is usually performed in an outpatient procedure room or day surgery centre and typically takes 30 to 60 minutes, depending on the number of veins being treated.
Most patients are pleasantly surprised by how comfortable the procedure is. You may feel a brief sting during the local anaesthetic injections and mild pressure as the catheter is positioned. During laser treatment, most patients experience little or no pain. After the procedure, it is common to notice mild bruising, tenderness along the treated vein, and a feeling of tightness or pulling in the thigh or calf. These symptoms are usually mild and settle over the following days to weeks.
EVLA is one of the most extensively studied treatments for varicose veins. Large clinical studies have demonstrated high vein closure rates exceeding 90–95%, excellent long-term symptom relief, significant improvements in quality of life, and low recurrence rates when appropriately performed.
Because of its excellent efficacy, rapid recovery and favourable safety profile, international guidelines from NICE and the European Society for Vascular Surgery (ESVS) recommend endothermal ablation, including EVLA, as a first-line treatment for suitable patients with truncal venous reflux.
Like any medical procedure, EVLA carries some risks, although serious complications are uncommon. Possible side effects include temporary bruising or discomfort, skin pigmentation over the treated vein, superficial vein inflammation (phlebitis), temporary numbness due to irritation of nearby skin nerves, failure of complete vein closure or later recanalisation, deep vein thrombosis (rare), and skin burns or infection (very rare).
Although EVLA is an excellent treatment for many patients, it is not suitable for every pattern of venous disease. Factors such as the size, course and anatomy of the affected vein, previous vein treatments, deep vein function and your overall health all influence whether EVLA is the best option. A duplex ultrasound scan is essential before treatment because it accurately maps the veins and determines the most appropriate approach.