Varicose vein surgery with an intravascular laser under expansion
Varicose vein surgery with endovenous laser under local anesthesia
Endovenous laser ablation (EVLA) is a modern treatment for varicose veins in which a laser beam is used to close off diseased veins from the inside. The procedure is performed under local anesthesia and is quick — usually about 30–60 minutes. Vascular surgeon Stefán E. Matthíasson performs this treatment at Lækningur in Reykjavík.
Intravenous laser is suitable for those who want a quick recovery after varicose vein treatment. Most people can return to work and daily activities within a few days. See a varicose vein doctor at Lækninga and get professional advice. Phone: 590 9200.
Preparing for endovascular laser surgery
Preparation:
- Fasting: Do not drink liquids or consume solid food 6 hours before the procedure.
- Painkillers: 1 hour before the operation , take the painkillers Panodil, Paracetamol or Paratabs 500 mg. If you weigh less than 70 kg then 2 tablets and otherwise 3 tablets.
- Shower the night before surgery and also the morning of surgery. Wash with regular soap. Do not apply creams or emollients to the skin on the day of surgery. Do not wear tight pants to the surgery due to the bandages/elastic stockings used after surgery.
- It is advisable to avoid the use of blood thinners (such as magnyl, codimagnyl, heartmagnyl, etc.) and anti-inflammatory drugs (NSAIDs) (e.g. Ibufen, Ibumetin, Naprox, Voltaren, Vóstar…) 4-5 days before the operation. Those who use Warfarin (Kóvar/Dicumarol), Xarelto, Pradaxa, Eliquis or similar blood thinners will receive special instructions. The same applies to the drugs; Grepid, Clopidrogel and Plavix which are blood thinners. Those patients who take blood-thinning drugs medications and/or heart medications are advised to be taken on the morning of the surgery with a sip of water. Use of birth control – or Menopause pills do not need to be stopped. Those who have diabetes and use insulin need to talk to the anesthesiologist a few days before the operation (telephone 590 9213).
- The Surgery Room has small, locked compartments for valuables/phones, etc. The Surgery Room ehf is not responsible for loss or possible damage to personal belongings. The use of smartphones during the recovery period is prohibited. Any recording/distribution of audio and video from the surgery room is also prohibited.
- Upon arrival at the operating room, you will meet the surgeon, anesthesiologist, and operating room staff. You will be given a gown to wear and disposable underwear. Your feet will be drawn and numbed. All patients must sign informed consent for the procedure.
- If you have a known allergy to medications, patches, disinfectants, etc., it is essential that this is disclosed before the procedure.
- The Icelandic Health Insurance (SÍ) pays for the operation mostly for those with health insurance in Iceland. Payment is collected for the operation. You can pay by credit card or credit card, but not by bill.
- After the operation: The operation is performed under general anesthesia. This is a special anesthesia method (tumescent anesthesia) and is performed in such a way that with a hair-fine needle, the surgical area is numbed with a cooled anesthetic solution. The only thing that patients feel is a prick and a feeling of pressure. Then, a sheath is inserted into the vein. A disposable laser guide is then threaded through it. This guide heats the inner lining of the veins to >100°C and closes it. In addition, smaller branches from the main veins are removed through needle punctures. The operations are performed with intravenous anesthetics similar to a gastroscopy. After the operation, you will be allowed to recover from waking up for ½-1 hour or until you are able to travel. Patients are not considered able to drive until the next day. It is advisable that patients do not stay alone until after returning home. Pain : Minor discomfort in the surgical area can be expected for the first few days. It is advisable to use painkillers if needed and they are available without a prescription in pharmacies (Paratabs/Panodil 500 mg, 2 tablets up to four times/day) or Parkodin without a prescription. Packaging : During the operation, the leg is placed in an elastic stocking. There is an elastic bandage on the outside that can be removed after 48 hours and discarded. The elastic stocking can also be removed and showered, but then put back on. The dressing under the elastic stocking can be removed at the same time before showering and discarded. The stocking is then worn for 5-7 days after the operation. Day and night. The stocking reduces pain, bruising and prevents swelling. Itching can accompany prolonged use of the dressing. Some people benefit from taking common allergy medications that are available without a prescription to relieve the itching. It is then advisable for patients to buy “flight socks” in the right size from a pharmacy, which reach up to the knee, and wear them from the 5th-7th day after the operation during the day for 1-3 weeks thereafter. Exercise : Generally, take it easy for the first 1-2 days after the operation. But take regular walks and do leg exercises by moving up and down around the ankle joint; “pump exercises”. This prevents swelling in the leg and reduces pain. Swimming and gymnastics after 10 days or when the puncture wounds are completely closed or healed. Complications : It is normal for the skin to bruise at the injection site. Also, for a thickening/string to form under the skin first in the place where the varicose veins were. Hirudoid cream, which is available without a prescription, can be used after 5-7 days to reduce the bruising. It is applied thinly to the bruised area 2-3 times a day until the bruise disappears. Bleeding and infections can occur. In case of infection, there is abnormally high pain in the wounds and possibly fever. If bleeding or suspicion of infection occurs, contact a doctor. Occasionally, long-term discoloration of the skin (staining) and also loss of sensation/loss of skin may occur. Blood clots after surgery have been described but are extremely rare. At the end of the surgery, everyone receives a blood thinner injection as a preventative measure. Wraps can cause discomfort or, in the worst case, blistering. In such cases, it is advisable to remove them or change their location.
- Post-treatment: Often, injections are given later (>3 months after surgery) into smaller varicose veins and aneurysms. For this purpose, the drug polidocanol (Aetoxysclerol) is used alone or as a foam. The drug closes these veins. The long-term success of this treatment is individual but never absolute and the injection treatment often needs to be repeated.
- Success : The long-term success of the procedure depends on, among other things, the extent and nature of the disease and a thorough preoperative assessment and ultrasound. An attempt is made to perform a permanent procedure, but it should be borne in mind that this is a chronic disease and that its underlying cause is poorly known, and therefore it can never be ruled out that varicose veins may form again or in other places over time. Recurrence of varicose veins after the best possible treatment is common in the long term.
- Work : Absences from work are individual, depending on the extent of the operation and the individual's job. It is not unusual to be off work for a few days after the operation and longer in exceptional cases. You may return to work whenever you wish without jeopardizing the success of the operation. Certificates for work are issued upon return.
