Endovenous Laser Ablation

Problem: Varicose Veins

Normally, veins return blood from the rest of the body to the heart. Veins must work against gravity to transport blood to the heart. Muscle contractions in the lower legs work as pumps and elastic vein walls help return blood to the heart. Tiny valves in the veins open to allow blood to flow towards the heart and close to keep blood from flowing backwards. Varicose veins occur when the valves in the veins do not close properly and allow blood to flow backwards. The blood pools in the vein, which causes the vein walls to weaken and expand, leading to varicose veins.

Vein problems often run in families, but there are some other factors that lead to their development. Some risk factors include:

  • The risk of developing varicose veins increases with age. Over time, the valves in the veins can become damaged from wear and tear.
  • Women are more likely to develop varicose veins than men.
  • Extra weight. Being overweight putts added pressure and stress on the veins, which can weaken their valves.
  • Standing or sitting in the same position for extended amounts of time is not good for blood flow.


The first treatment option for varicose veins is conservative therapy such as compression stocking. Compression stockings squeeze the leg while being worn, which helps the muscles and veins work properly in returning blood to the heart.

Should conservative therapy fail to improve symptoms, there are additional treatment options. One option is endovenous laser ablation (EVA). This treatment involves using a laser to close the problem vein, which is later absorbed by the body. Dr. Robbins marks the area where the laser is to be inserted into the leg. After the entry site has been numbed using local anesthesia, Dr. Robbins inserts a catheter into the problem vein through a tiny incision, usually immediately below the knee. The laser is then inserted into the vein through the catheter and positioned near the top of the leg. Dr. Robbins next slowly withdraws the laser from the leg. Heat from the laser causes the vein to seal. The heat from the laser is not painful because the vein has also been numbed by local anesthesia. Once he reaches the end of the vein being treated, Dr. Robbins withdraws the laser and catheter from the leg. The entry point is then closed (usually it doesn’t require stitches) and pressure bandages applied. A compression stocking is put on over the pressure bandages to minimize bruising and swelling. The stockings should be worn for a complete 72 hours immediately following the procedure and then during the day for 1 to 2 weeks.

This procedure is minimally invasive and is done in our office. The treatment takes 60 to 90 minutes depending on any additional treatments such as microphlebectomy (the removal of small, superficial varicose veins). Complications of EVA are rare, but they include the following: thrombophlebitis, deep vein thrombosis, and infection at the incision site.