Instead of removing the vein, a thin laser fibre is passed up inside it and the vein is sealed shut along its length. There is no groin cut, bruising is much less than with stripping, and most people are back at desk work within a few days.
Endovenous laser ablation closes a refluxing saphenous vein from within. A fibre is passed into the vein through a needle puncture under ultrasound guidance, local anaesthetic is injected around the vein, and laser energy seals it as the fibre is withdrawn. It is done awake, takes under an hour, and most patients walk out and return to desk work within two to four days.
A varicose vein problem usually starts in one of the long surface trunks, where the valves have failed and blood falls back down the leg. Stripping deals with that by pulling the vein out. Laser ablation deals with it by sealing the vein shut and leaving it in place, where the body gradually absorbs it over months.
The vein is entered low down with a needle, so there is no cut in the groin. A fibre is threaded up inside it under ultrasound guidance until its tip sits just short of the deep vein. Dilute local anaesthetic is then injected all around the vein along its whole length. This does two jobs: it numbs the area, and it forms a cushion of fluid that protects the skin and nerves from the heat.
The laser is switched on and the fibre withdrawn slowly. The vein wall heats, contracts and seals. The 1470 nm wavelength is absorbed strongly by water in the vein wall itself rather than by blood, which means the heat is delivered where it is needed and there is less bruising and post-operative discomfort than with the older 810 to 980 nm lasers.
Laser suits most patients, but not all veins. The duplex scan settles it, and being honest about the exceptions matters more than offering the newer option to everyone.
The vein is scanned and marked while you stand, and the access point chosen, usually around the knee or calf.
The vein is entered with a needle under ultrasound guidance. No cut is needed.
The laser fibre is advanced inside the vein until its tip sits a safe distance short of the deep vein, checked on ultrasound.
Dilute local anaesthetic is injected all around the vein along its length. It numbs the vein, compresses it onto the fibre, and forms a protective cushion between the heat and the skin and nerves.
The laser is activated and the fibre withdrawn steadily. The vein wall contracts and seals behind it.
Bulging surface veins can be removed through tiny punctures in the same sitting. The leg is then bandaged or fitted with a stocking, and you walk straight away.
You walk out. Mild tightness along the vein is normal. Most people drive themselves home if no sedation was used.
Compression stocking is worn as instructed. A firm tender cord develops along the treated vein. Simple painkillers are usually enough. Walk regularly.
Most people back at work within the first week. Tenderness along the cord peaks around week two and then eases. Bruising, where present, fades.
The cord softens and becomes impalpable as the vein is absorbed. A follow up scan confirms the vein has stayed closed.
Symptoms usually improve quickly and bruising is noticeably less than after stripping. There is no groin scar, only a needle puncture. A firm, tender cord can be felt along the treated vein for several weeks as it scars down, and this is expected rather than a complication. The treated vein cannot come back, but new veins can become varicose over the years, and a small proportion of treated veins reopen and need further treatment. Thread veins are not treated by this procedure and may need separate attention afterwards.
Heat inside a vein brings a specific set of risks, different from those of open surgery.
Walking and compression do most of the work in the first fortnight.
The procedure itself is comfortable once the local anaesthetic is in, but the injections sting, and the treated vein is tender for two to three weeks afterwards. It is less painful than stripping, not painless.
It is sealed shut and left in place. The body absorbs it gradually, which is why you can feel a cord for a while.
It suits most veins. A very large, very twisted or very superficial vein can be unsafe or ineffective to treat with heat, and stripping is then the better operation.
Surface thread veins come from different, tiny vessels and are treated separately. Treating the trunk does not make them disappear.
Both laser and open surgery are done here, so the recommendation is not shaped by what is available. Some legs genuinely do better with stripping, and saying so is part of the job.
Cost depends on how many veins are treated and whether one or both legs are done. Laser consumables make the procedure cost more than open surgery in some settings, and less overall once time off work is counted. Treatment for symptomatic varicose veins is commonly covered by health insurance and government schemes; treatment of thread veins for appearance alone is not. A written estimate follows the duplex scan.
The questions that come up whenever laser is mentioned.
Ask your question →For most patients it means less bruising and a faster return to work, and it avoids a groin cut and a general anaesthetic. It is not better for every vein. A very large, very tortuous or very superficial trunk is often safer and more reliably treated by stripping. The duplex scan decides.
The local anaesthetic injections sting for a minute or two. The laser itself is not felt. Afterwards the treated vein becomes a tender cord for around two to three weeks, which is the most uncomfortable part and is managed with simple painkillers and compression.
That is the treated vein scarring down. It is expected, and it gradually softens and disappears over three to six months as the vein is absorbed.
Short flights after about two weeks, longer flights after four, and wear your compression stocking. Flying too soon after any vein treatment raises the risk of clot.
No. Thread veins come from separate tiny vessels in the skin. Treating the trunk stops them being made worse, but existing ones need separate treatment if they bother you.
In a small proportion of cases, yes. That is why a follow up scan is done. If a segment has reopened it can usually be treated again, often with foam rather than repeating the laser.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
