LASER stands for 'Light Amplification by the Stimulated Emission of Radiation'.

Endovenous Laser Ablation (AVLA) was invented by three doctors following a discussion at a venous meeting back in 1998. 

Dr Robert Min of the USA pioneered the treatment and released a publication in 2001. This showed that, up to 1 years 2 months post treatment of the great saphenous vein with 810 nm diode laser energy, a 100% rate of closure had been achieved with no significant complications.

From this it became very apparent that when you heat a vein with sufficient energy to destroy the vein, it then shrivels away. This allowed no blood to return back down the vein as the vein was now closed, in the same way that no blood returns back down the vein initially after the vein has been stripped out. The result of this means that all the conditions associated with varicose veins such as eczema, thrombophlebitis and leg ulcers were kept under control.

From this initial study many new lasers have been developed, with new wavelengths, different types of fibres altering the way in which laser energy is delivered and new technique to use them.

Even though there are many alternatives now on the market, the basic procedure remains consistent:

Using ultrasound for guidance, a needle is inserted into the vein. A wire is then passed through the needle and into the vein. A long tube is then passed over the wire and the wire removed. This leaves the tube in place within the vein which can be easily visualised using the ultrasound. (This is known as the “seldinger technique” and is widely used in intra-vascular procedures).

Once the tumescent anaesthesia is in place the laser fibre can then be advanced down the tube and into the vein under ultrasound guidance. The fibre is then accurately positioned, again using the ultrasound, about 2cm below the level of the sapheno femoral junction, when treating the great saphenous. 

The laser is then fired and the sheath with the laser fibre protruding 2cm out of the end of the sheath pulled back down the vein at the correct speed, usually between 5 and 6 seconds per centimetre to delver energy in the region of 60-80 joules per cm of vein.

Research shows that with this amount of energy the vein is destroyed and limits the amount of bruising and pain post operatively to the patient. The body then re-routes the blood via veins that are working correctly.

One of the main advantages with this technique over the conventional stripping out of the vein, is that because the vein is closed in situ and not removed there is no way in which the vein can re-grow. The proteins in the wall of the vein has been denatured using the laser energy and so the bodies own defence mechanism does not recognise the vein as being part of its own system and the white blood cells come along and destroy the vein until it has completely gone.

Endovenous laser treatment of the vein allows patients to be treated on the NHS or in a private setting, as a walk in - walk out treatment, with the whole procedure taking about 1 hour from start to finish and the patient leaving with just a compression stocking on to aid healing.

One of the latest laser to hit the market is the Fotona XP 2 which is a QCW Nd:YAG laser which can generate peak powers beyond 5Kw, ensuring the highest performance efficiency. The advantages the Nd:YAG laser has over the diode lasers is that it strikes a perfect balance in its absorption in various body chromophores, allowing it to be safely, effectively and efficiently used in numerous procedures including endovenous laser ablation.

Numerous studies already show that the Nd:YAG laser minimizes patient discomfort, increases success rate and shortens recovery time. The Fotona is able to deliver energy as either a continuous wave or in pulsed wave allowing better control of the procedure and more versatility.