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Varicose Vein Laser Treatment In Mumbai

Minimally Invasive EVLA (Endovenous Laser Ablation) for Effective, Scar-Free Varicose Vein Treatment at Shree Hospitals

Varicose veins - enlarged, twisted, visibly prominent veins in the legs caused by failure of the venous one-way valves - affect approximately 25% of women and 15% of men at some point in their lives, causing aching, leg heaviness, swelling, and in advanced cases, skin changes, venous ulcers, and DVT. At Shree Hospitals, our specialist vascular surgeons offer EVLA (endovenous laser ablation) - the gold-standard, minimally invasive treatment for great saphenous vein (GSV) and small saphenous vein (SSV) reflux - along with ultrasound-guided foam sclerotherapy (UGFS) and phlebectomy, delivering highly effective treatment with no general anaesthesia requirement, immediate mobilisation, and minimal downtime.

What is Varicose Vein Laser Treatment (EVLA) and How Does It Work?

Varicose veins develop when the venous valves within the superficial venous system of the leg become incompetent. The one-way valves in the leg veins normally prevent blood from flowing backwards (downwards under gravity) between heartbeats, directing all blood flow upward toward the heart. When valves fail, blood pools and refluxes downward, causing elevated pressure in the superficial veins. The great saphenous vein (GSV) - which runs from the groin to the ankle on the inner aspect of the leg - and the small saphenous vein (SSV) - which runs up the back of the calf from the ankle to behind the knee - are the two main trunk veins whose valve failure is responsible for the majority of varicose veins. The CEAP (Clinical Etiological Anatomical Pathological) classification grades chronic venous disease from C0 (no visible signs) to C6 (active venous ulcer). EVLA is effective for C2 to C6 disease with confirmed truncal reflux on duplex ultrasound.

EVLA (endovenous laser ablation) works by delivering laser energy (most commonly at 1470nm wavelength - a wavelength absorbed by water in the vein wall, producing uniform thermal damage) through a thin laser fibre inserted into the great or small saphenous vein under ultrasound guidance. A solution of dilute local anaesthetic and adrenaline (tumescent anaesthesia) is injected around the vein under ultrasound guidance before the laser is activated - this compresses the vein around the laser fibre (to maximise thermal contact), protects the surrounding tissues from thermal injury, and provides post-procedure analgesia for several hours. The laser fibre is then withdrawn at a controlled rate (typically 1 to 2mm per second) while delivering continuous or pulsed laser energy (typically 30 to 80 joules per centimetre of vein treated, depending on the vein diameter), thermally ablating the vein wall and causing permanent occlusion and fibrotic obliteration of the treated trunk vein. Blood flow then redirects entirely to the deep venous system, and the varicose veins fed by the ablated trunk vein subsequently collapse.

At Shree Hospitals, every patient with varicose veins undergoes Duplex Ultrasound mapping by a vascular surgeon and vascular technologist before any treatment is planned. Duplex ultrasound combines real-time B-mode ultrasound imaging (showing the vein structure) with colour flow Doppler (showing blood flow direction) to precisely map the incompetent truncal veins, identify all incompetent perforating veins, assess the deep venous system (to exclude deep vein thrombosis - DVT or deep venous insufficiency which would change management), and plan the treatment strategy. The treatment plan - EVLA of the GSV alone, EVLA of GSV plus foam sclerotherapy of residual varicosities, or EVLA plus concurrent phlebectomy - is agreed with the patient at the pre-treatment consultation.

Who Needs Varicose Vein Laser Treatment?

• C2 varicose veins causing significant symptoms: aching, leg heaviness, throbbing, night cramps, or itching
• C3 oedema (leg swelling) attributed to chronic venous disease
• C4 skin changes: lipodermatosclerosis, venous eczema, atrophie blanche - indicating high-risk skin at risk of ulceration
• C5 healed venous ulcer - requires treatment of underlying venous reflux to prevent ulcer recurrence
• C6 active venous ulcer - urgently requires treatment of the incompetent superficial veins to promote ulcer healing (compression alone has a lower healing rate than compression plus endovenous treatment of the underlying reflux)
• Symptomatic varicose veins affecting quality of life even if advanced skin changes are not yet present

Is EVLA Right for You?

• Duplex ultrasound confirms GSV or SSV reflux (reflux duration over 0.5 seconds in the standing position) as the source of the varicose veins
• The GSV diameter at the sapheno-femoral junction is appropriate for EVLA (most units treat GSV diameters up to 12 to 15mm; very large GSVs may require a modified approach)
• There is no DVT in the deep venous system (exclude with duplex before treatment)
• You are not pregnant (defer all varicose vein treatments until 3 months after delivery)
• Compression stockings have been tried and are insufficient to control symptoms
• You understand that residual surface varicosities after EVLA may require a second session of foam sclerotherapy at 6 to 8 weeks

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Our Approach To Varicose Vein Laser Treatment

At Shree Hospitals, our approach to varicose vein treatment is entirely duplex-guided and evidence-based. We do not treat the surface varicosities without first treating the underlying truncal reflux - the root cause of the problem.

Duplex Ultrasound Vein Mapping

Every patient is assessed with a comprehensive Duplex Ultrasound mapping session before treatment planning. The GSV is assessed from the sapheno-femoral junction (SFJ) at the groin to the ankle, confirming the presence and extent of reflux (with Valsalva manoeuvre and calf compression-release). The SSV is assessed from the sapheno-popliteal junction (SPJ) to the ankle. Perforating veins greater than 3.5mm in diameter with outward reflux in the standing position are mapped. The deep venous system (femoral vein, popliteal vein) is assessed for compressibility and flow (to exclude DVT) and for deep venous reflux. The maximum GSV and SSV diameter at the junction is measured as this determines laser energy settings. The vein map is marked on the skin with a marker pen and documented with ultrasound images for the procedure.

EVLA Procedure Under Tumescent Anaesthesia

The EVLA procedure is performed in a procedure room (no general anaesthesia or operating theatre required). Under ultrasound guidance, the GSV is accessed with a 21-gauge needle and a 4 to 5F sheath is inserted and advanced under ultrasound guidance to a point 2cm below the SFJ (below the epigastric vein entry point, to protect the femoral vein from thermal injury). The laser fibre is inserted through the sheath and its tip position confirmed on ultrasound. Tumescent anaesthesia (dilute lidocaine 0.1% with adrenaline and sodium bicarbonate, typically 200 to 500ml per leg) is then injected in the perivenous space along the entire length of the vein to be treated using a peristaltic pump, compressing the vein and providing anaesthesia and thermal protection. The 1470nm laser is then activated and the fibre withdrawn at a controlled rate (calibrated to deliver the target energy dose per centimetre). Post-procedure compression stockings (Class 2, 18 to 21 mmHg) are applied immediately.

Treating Residual Varicosities

After EVLA of the truncal vein, residual surface varicosities may remain - the feeding trunk is eliminated but the surface clusters may take weeks to months to fully disappear, or may require direct treatment. At 6 to 8 weeks after EVLA, a duplex ultrasound review confirms successful ablation of the treated trunk vein. Residual surface varicosities are then treated with ultrasound-guided foam sclerotherapy (UGFS): polidocanol (1 to 3%) or sodium tetradecyl sulphate (STS) (0.5 to 1%) foam is prepared in a standard Tessari technique (1:4 sclerosant to air ratio through a 3-way stopcock) and injected directly into the residual varicosities under ultrasound guidance to produce direct sclerosant damage to the vein wall. Ambulatory phlebectomy (removal of large surface varicosities through 2 to 3mm stab incisions under local anaesthesia) may be performed at the same session as EVLA or deferred to the follow-up appointment depending on the extent of surface varicosities and patient preference.

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