Laser is the newest method to address significant varicose veins.  The laser is designed to replace surgical stripping of the main diseased vein which feeds the varicose tributaries.  The varicose tributaries themselves need to be addressed either in an immediate or delayed fashion after laser ablation of the incompetent feeding vein in the thigh or calf.  The source vein is generally the long saphenous vein which runs down the inside aspect of the thigh.  This is identified using ultrasound scanning and punctured using a thin needle.  Through the needle a wire and hollow tube or catheter is placed. Through this the laser fiber is introduced, generally to the groin.

Large amounts of diluted local anaesthetic is then placed around the vein.  This compresses the vein onto the fiber and also functions as a heat sink.  The laser fiber is activated and slowly withdrawn over a 2 minute period. It causes direct thermal injury to the vein which results in it contracting or closing.

It is my practice to immediately address the varicose tributaries using surgical phebectomies.  This involves making a series of small incisions and teasing out the varicose veins.  The phebectomie sites are closed using a steri strip – much like a bandaid.  A compression dressing is applied which is kept on overnight.  This is removed after 24 hours and an above knee compression stocking is used for the next 10-14 days.

The advantages of the procedure include:

1. Avoidance of pain and discomfort of surgical stripping hence faster return to work.

2. Less bruising.

3. The most recent evidence indicates there is a lower chance of the veins returning.

Associated risks:

1. Less than 1% chance of DVT (a clot involving the deep veins in the leg).

2. Small risk of a skin burn if excessive heat is transferred from the laser fiber on to the skin or tissues of the leg.

3. Small risk of infection at the sites of surgical phebectomy.

A significant percentage of patients will experience some tightness in the leg as a result of the vein becoming contracted in the thigh, particularly as they stretch out into normal walking.  This is resolved generally within 2 weeks.