Endovenous Thermal Ablation or Endothermal Ablation (ETA) is the generic term for all methods of treating refluxing superficial veins using heat energy delivered from inside the vein under local anaesthesia.
When laser is used as the energy source the treatment is called Endovenous Laser Ablation (EVLA) and one of the first systems manufactured to use a laser was named EVLT. In fact EVLT (Endovenous Laser Therapy) is a registered trademark that only refers to one product from a company called Diomed. Radiofrequency may also be used as a form of ETA, but EVLA which uses a laser is currently more popular with vein specialists in the UK.
According to a study by CJ Evans et al in 1999, varicose veins are present in approximately 1 in 3 adults in the Western world.
Treatment of varicose veins is generally considered to be a medical matter, although the main implications are usually cosmetic, in that people don’t like to live with the appearance of them, usually on their legs. Pain and discomfort are also a factor. Sufferers are often referred by their GP to a vascular or vein specialist for diagnosis of the problem and to discuss treatment options.
Unlike thread or spider veins, varicose veins are situated beneath the skin, being skin coloured or bluish-green and more than 2mm in diameter. They are more serious than thread veins and they can be painful (or achy) and are a sign of leg pump or venous failure, almost always superficial venous reflux.
Different treatment options are available for varicose veins. Traditional treatment is ligation or tying of the affected veins and stripping them from the leg. This a surgical procedure which requires general anaesthetic and up to six weeks ‘down time’ away from work. As well as being painful, this also leads to the veins growing back again in the majority of cases, a process known as neovascularisation. Although still available on the NHS, this is considered by many vascular specialists to be an outdated and unnecessary form of treatment. Other options include foam sclerotherapy where a sclerosant substance is injected in the vein causing the vein walls to collapse.
In 1999, Consultant Vascular Surgeon, Prof. Mark Whiteley became the first person in the UK to perform ETA using radiofrequency (RF) energy to generate the heat inside a vein, thus destroying it and allowing it to be reabsorbed by the body without any regrowth. The procedure was performed using ultrasound guidance, via a tiny keyhole incision of 2 or 3mm.
Following on from the success of this method of treating superficial venous reflux, several other doctors came up with the idea of using a laser (initially an 810nm diode laser) to generate the heat inside the varicose vein which destroys it, instead of RF energy. The first results, which were extremely encouraging, were published in the Dermatologic Surgery Journal in 2001 by Navarro et al in a clinical paper entitled ‘Endovenous laser: a new minimally invasive method of treatment for varicose veins--preliminary observations using an 810 nm diode laser’. This culminated in a technique trademarked as EVLT or Endovenous Laser Therapy using a device manufactured by Diomed which used the 810nm wavelength.
Endovenous Laser Ablation or EVLA is now the recognised generic term for using a laser to treat veins using heat. EVLA covers all systems, and the differing wavelengths used, rather than just the EVLT technique and device at 810nm, and is therefore the generic term we will refer to in this FAQ as vascular surgeons can use a variety of equipment for this procedure.
If you are considering Endovenous Laser Ablation for varicose veins, the following information will give you a basic understanding of the procedure. It can't answer all your questions, since a lot depends on your individual diagnosis. Please ask your vascular specialist about anything you don't understand.