Dr. Mueller is the finest physician I have ever had. I have entrusted my life in his hands for over 15 years and he is the only Doc I would empower to be my medical team leader. His judgment and diagnostic & communication abilities are impeccable, as is his medical advocacy on my behalf. He actually listens, gives me full attention, and truly cares. He is always reachable immediately; I couldn’t be happier in the concierge program, which gives me extra security and confidence and I love the instant priority, no wait appointments, as well as the value, added tests that would not normally be covered.
Endovenous Laser Ablation
Endovenous Laser Ablation is also known as EVLA, EVLT®, or ELT
EVLA has rapidly revolutionized the treatment of Vein Disorders since its FDA approval in 2002. With hundreds of thousands of procedures performed around the globe, successful vein closure rates of up to 98% have been published for up to 5 years follow-up. dEVLA has nearly completely replaced the former gold standard for treatment of diseased large veins, surgical vein stripping, due to a striking combination of superior effectiveness (up to 60% recurrence rate with surgery), markedly reduced complication rate (25 fold reduced rate of blood clots of the deep veins, no wound complications as seen with surgery), & the patient-friendly nature of the procedure (no surgical incision/wound, no hospitalization, no general anesthesia, in-office treatment, minimal if any downtime).
EVLA replaces the surgical removal of diseased large veins with treating the vein in place from the inside and closing it, using focused, localized heat generated by focused, coherent light from the laser. At Sutton Place Laser Vein Care we use the pioneering and industry leading vein laser manufactured by Diomed® (since acquired by Angiodynamics, Inc.®), a diode laser that generates focused light at exactly 810 nm wavelength, in the near infrared (invisible) end of the spectrum. We upgraded our laser machine to the state of the art, latest generation 1470 nm wavelength, delivering to our patients either no or minimal levels of pain and/or bruising post procedure in nearly every case.
This remarkable technology is a powerful tool, with no radiation exposure, and which applies heat to the inner vein wall, which while intense, is at the same time remarkably focused, penetrating only a fraction of a millimeter outside the vein wall. This unique and exciting technology, all light based, allows for the high success rate and very low complication rate of the procedure while enabling easy treatment in the comfort of a private office, without the risks of immobility or general anesthesia, nor the downside of downtime and prolonged recovery.
EVLA can be performed in as little as 45-60 minutes, right in our office. EVLA is a walk in, walk out procedure; you can resume normal activities immediately with practically no restrictions. While not required, we encourage the use of a low dose oral Valium-like sedative just to enhance relaxation and comfort. One or more veins can be treated with this. One vein is treated with each treatment session in order to avoid excessive procedure time & excessive anesthetic exposure. As EVLA is directed at treating the root problem causing varicose veins, the deeper feeding veins that have leaking vein valves, relapse rates are minimized. It is important though to acknowledge that vein disease is chronic and usually progressive, so even after a perfectly successful vein procedure, new veins can always develop over time.
Also, while EVLA will often cause significant or complete flattening out of varicose veins by itself, many patients will need additional vein procedures (sclerotherapy or phlebectomy) after EVLA directed at treating the varicose veins themselves, once the root cause has been treated.
The patient is covered with sterile drapes and the leg is disinfected; key staff wears sterile gowns and gloves. Ultrasound imaging is used to localize the optimal spot on the leg to access the vein, after a small injection of local anesthetic (lidocaine, similar to Novocaine [R]) to numb the skin. The laser fiber, a highly engineered and refined flexible optical fiber only about 1 millimeter wide, is threaded into the vein via a needle and catheter placed into the vein under ultrasound imaging guidance. Positioned exactly at the top-most level of vein valve leaking, the length of vein to be treated (usually from the groin level to just above or below the knee), is injected with more local anesthetic in order to numb the leg, protect nerves and skin, absorb excess heat generated by the laser light, and to compress the vein onto the laser fiber, to enhance contact with the inner vein wall, the treatment target.
The laser is activated, the laser fiber is gently and slowly withdrawn down the length of the leg and within a couple minutes it is entirely out of the leg and the procedure is over. Heat applied to the inner vein wall closes the diseased vein from the inside; the analogy is heat-sealing the vein and closing it like a zipper or like a lamination machine sealing the pouch to the document inside. Ultrasound imaging is used during the whole procedure to guide the process. Immediately after the procedure, ultrasound imaging is used to assess closure of the vein as well as to assess for any blood clots. Ultrasound is used again frequently in follow-up, at 3-7 days, 1 month, every 3 months for the first year, then annually post procedure.
A compression stocking is placed over the leg, which is to be worn around the clock for the first 2 days, then daytime only for the remainder of 2 weeks, or as long as one tolerates them. The patient is asked to get up and walk around the office for 20 minutes to stimulate blood flow, then walk 30-60 minutes a day for the next 2 weeks. Activities and work are not restricted at all, other than avoiding sunbathing, saunas / hot tubs, and intense gym workouts for those first 2 weeks. Arnica montana, a homeopathic herbal lotion, as well as Tylenol and/or ibuprofen (the latter when there are no contraindications) are prescribed to prevent or reduce bruising and discomfort after the procedure. The patient is given post-procedure verbal and written instructions and given the cell number of the medical director or covering staff for 24/7/365 phone access in case of problems or questions.
Follow up visits to examine the leg and inquire about any side effects and to determine the need for any adjunctive vein procedures also occur after the procedure.
For more information, including videos, please see these informative websites:
- www.venacure-evlt.com (manufacturer of the pioneering laser system we use, has informative videos)
EVLT® is a registered trademark of AngioDynamics, Latham, NY