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Which patients can have EVLT for varicose veins?

Q What is EVLT and which patients with varicose veins is it suitable for?

A EVLT stands for Endovenous Laser Treatment and was recently approved by NICE. It is an alternative operation to 'high tie and strip' for varicose veins.

Using ultrasound guidance, a needle is inserted into the long saphenous vein at the knee and a laser fibre passed up the leg to the groin.

The laser then seals the vein from within instead of stripping it out. There is no incision in the groin.

EVLT can be performed entirely under local anaesthetic. Post-operative bruising and pain are less than after standard surgery, resulting in a shorter recovery time.

Residual veins may remain in the calf after treatment of the thigh vein, and these may require further attention by local avulsions or injections as a 'tidy up' procedure.

EVLT is not suitable for all patients. Inserting the needle and passing the guidewire mean that the ideal patient has a reasonably large vein at the knee (5mm or larger) and a reasonably straight vein in the thigh ­ tortuous veins can cause the wire to get stuck.

It is not possible to tell which patients are suitable using the 'Mark 1 eyeball test'. Interested patients should be seen by a surgeon experienced in the technique and undergo a duplex ultrasound scan.

In my experience about 60 to 70 per cent of patients with varicose veins are suitable for EVLT.

EVLT is not widely available on the NHS as yet. Costs for private treatment vary between £1,500 to £2,000 per leg. EVLT is recognised by all the major insurance companies.

Eddie Chaloner, consultant in vascular surgery, University College Hospital, London

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