Endovenous laser therapy

The endovenous laser treatment (EVLT) or endovenous laser ablation (EVLA) is a minimally invasive or operationsersetzende method for the treatment of varicose veins . Surgical incisions such as vein stripping are not required with this method. A catheter is inserted into the vein through a small puncture site under ultrasound control up to the area to be treated. The vein laser, which is only 2–3 millimeters thick, is then inserted into the vein through this venous catheter . The inner wall of the veins is heated to approx. 70 degrees Celsius by the laser irradiation and is thus deliberately damaged. The treated vein becomes stuck after the treatment, which closes the vein and prevents the pathological backflow of the venous blood (reflux). The closed vein hardens initially, completely recedes over the course of a few months and is broken down by the body or converted into connective tissue. Endovenous laser therapy is carried out on an outpatient basis under local anesthesia . Usually, the patient can resume his usual activity immediately after the procedure. Further advantages compared to the invasive stripping process are the good cosmetic results, since scalpel cuts can be dispensed with and thus scarring is avoided. Wearing compression stockings for a week reduces the formation of bruises and supports the healing of the treated vein sections. In addition, if necessary, thrombosis prophylaxis takes place over a period of about eight days.

The IGeL monitor of the MDS ( Medical Service of the Central Association of Health Insurance Funds ) rates the laser therapy as "unclear" compared to the standard operation. After a systematic literature search, the test portal comes to the conclusion that both methods perform equally well and have the same number of side effects. This applies, for example, to the questions of how many new varicose veins develop, how quickly the patients get fit for work again, and how much pain and wound infections can arise. The IGeL Monitor is based on a systematic analysis of the scientific literature and evaluated seven review articles and four more recent individual studies that compared both measures. The most important source is a British review article (Cochrane Review) from 2016. However, older laser devices were used in the studies than were usual at the time of the assessment. In 2012, the IGeL-Monitor classified the performance as "generally positive".

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• TM Proebstle, HA Lehr, A. Kargl, C. Espinola-Klein, W. Rother, S. Bethge, J. Knop: Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles. In: J Vasc Surg . 35 (4), Apr 2002, pp. 729-736. PMID 11932671
• JC Ragg: Comparison of radio wave and 810nm laser in the saphenous vein of the same patient. In: Wiener Medical Wochenschrift. Suppl. 123/10, Abstracts Venalpina IV
• JC Ragg: Comparison of 810 to 1470 nm laser systems in identical veins. Union International du Phlebologie, Monaco 2009.

Individual evidence

1. ↑ IGeL-Monitor: Laser treatment of varicose veins , accessed on February 14, 2019. More on the justification for the assessment in evidence , accessed on February 14, 2019.
2. ↑ The family doctor: Varices: laser and surgery are the same , January 20, 2018. Medical Tribune: IGeL assessment: surgery and laser for varicose veins are equal , January 28, 2018
3. ↑ Paravastu et al. Endovenous ablation therapy (laser or radiofrequency) or foam sclerotherapy versus conventional surgical repair for short saphenous varicose veins. Cochrane Database Syst Rev. 2016 Nov 29; 11: CD010878.
4. ↑ Deutsches Ärzteblatt: Use of laser treatment for varicose veins downgraded to “unclear” , December 19, 2017.

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