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. The entire procedure is done in an office setting under local anesthetic which 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 2mm 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 laser treatment. In these cases our surgeons 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). Unfortunately, EVLT is not currently covered by OHIP.

VenaSeal is a new therapy that builds on and extends on the advantages of laser therapy. The concept is to use a form of cyanoacrylate glue that has been designed and modified specifically for use in varicose veins. This glue has been in use in medicine in other parts of the body for over 50 years, and has been shown to be non-toxic, non-reactive, and safe. Rather than using laser energy to fuse the vein together, this procedure uses glue to shut the vein.

This provides two key advantages to patients. Firstly, during the procedure, because there is no laser required, there is no need to freeze along the entire length of the vein. This means that fewer freezing needles are required to perform the procedure. Secondly, after the procedure patients only need to wear compression socks for 24 hours after the procedure, and then for 1 week only during the day. Patients are likely to experience less bruising following the glue procedure also.

Results from a well performed randomized controlled trial were recently published comparing VenaSeal to other endovenous modalities, found a similar success rate (vein closure rate of 99%). Like EVLT, some perforating veins or large branches may need to be removed following the procedure using small incisions at a later date. Also similar to laser, any discolouration of the skin present before the procedure will still be present. Finally, also similar to the laser procedure, spider veins are unlikely to respond to VenaSeal and will require subsequent injections.