Endovasal laser coagulation (EVLK) of the veins of the lower extremities
Endovasal laser coagulation (EVLK)is a modern method of getting rid of the stem extension of veins with the help of the thermal impact of laser energy. At the same time the vein is preserved, as well as with the standard, habitual operation, it is burned from the inside out. It promotes thrombotic occlusion of the vein, its compression and gradual resorption of blood reflux. The technique is carried out under the control of a special scanning of color duplex, which allows not to cut the skin.
Video with our doctors. The real operation of EWLK
The history of the method of "Endovazal laser coagulation EVLK" (Wikipedia)
The first joyful reports about the possibility of using a laser in the treatment of phlebology patients appeared in 1981. Dr. Anderson RR and colleagues used a dye laser having a wavelength of about 577 nm, the principle was to damage the microvessels of the skin. In the development of the foundations of technology, the process of absorbing the energy of a laser with a certain wavelength was laid by the tissues, and this resulted in their selective destruction.
Only 90-ies of the last century, when new semiconductor structures saw the light, it became possible to produce compact lasers. These devices had a great service life at a fairly low cost. In 1998-1999, the first information about the beginning of clinical manipulations based on intravascular application of a diode laser for endovasal laser coagulation began to appear. As a result, only in 2002 this method was patented by V.Meloni and his colleagues.
Since the appearance of the method -endovasal laser coagulation of varicose veins, videowhich was removed for a deeper study of the process, there was a tendency to increase the power of energy, which is fed into the vessel. The earliest works were performed on a power of not more than 15 W, and after research work carried out by a number of scientists, there were reports of large power figures not exceeding 40 W.
Endovazalnaya laser coagulation EVLK in Moscowis of great interest to both surgeons and their patients. Every year the number of publications and studies on this subject increases. Endovasal laser coagulation of varicose veins, pricewhich can differ depending on the equipment, every year becomes more popular, due to the education of patients, is in great demand.
Despite all the existing experience, the technology of endovasal laser coagulation is still very far from perfect. Therefore, research continues in two directions: standardization of technology and refinement of indications, elucidation of the optimal wavelength of the laser beam.
Endovasal laser coagulation (EVLK) - what is it?
The principle of performing the procedure of endovasal laser coagulation is based on the thermal effect of laser radiation on the inner part of the vein surface. But, as it was found out with the help of a huge number of different types of research, the laser does not fully affect the surface of the vessel walls. Most of the energy is absorbed by the blood contained in the vessel. In the blood, already under the influence of the light pulse, vapor bubbles are formed that contact the vein wall, as a result of which the thermal effect occurs. Further coagulation of proteins occurs in deeper layers due to damage to the endothelium.
It is the destruction of the endothelium that is of primary importance as a result of treatment. A portion of viable endotheliocytes is preserved, which in the future are an important source of wall regeneration. The process of destruction must be complete, and this is possible only as a result of creating in the lumen of the vessel the optimum energy density of the laser radiation, which leads to its "charring". However, you should carefully choose the power of the laser, otherwise with a stronger effect of the device, the wall of the vessel is perforated.
The latest models of lasers for endovasal laser coagulation have a wavelength of about 1,47 μm, at which the laser radiation is absorbed more precisely by the water of the venous wall and the blood itself. Immediate direct exposure to the vein wall reduces the radiation strength, the appearance of charring and the heating of the working surface. This contributes to a lesser probability of perforation of the vessel wall and the appearance of pain in the postoperative period. This wavelength is ideal for larger venous trunks that have a diameter of more than 10 mm.
Endovenous laser coagulation - after the procedure
After the procedure -endovasal laser coagulation of varicose veins, photowhich can be seen on the network, the processes caused by the burn continue to form necrosis in the vein wall, which lasts about a week. If the thermal effect is insufficient, at the end of this period, thrombophlebitis, soreness and hyperemia along the vein can occur. This can be avoided with adequate heat exposure. Further, all the described processes replace the organization process, when a thrombus filling the lumen of a vein is gradually replaced by a connective tissue. After a year, the vein should look like a connective tissue cord.
Endovenous laser coagulation of veins - indications and contraindications
Endovasal laser coagulation (EVLK veins), like any medical procedure, has both indications and contraindications.
- Priustevoe expansion of the vein should be no more than 10 mm. The widest lumen of the veins can be eliminated with the help of this procedure, but the techniques for carrying out such manipulations are not yet standardized, and the results are often unsatisfactory.
- Expanded varicose inflows - the minimum amount.
- Straight trunk of the vein. In the case of bends, it becomes impossible to pass through the venoendovasal method, neither by a catheter, nor by a probe, nor by a conductor.
- Trophic lesions of lower leg. This indication must be isolated for a separate manipulation, which is endovasal laser obliteration.
- Established thrombophilia, since the method of endovasal laser coagulation involves the formation of a thrombus near the lumen of the femoral or popliteal vein and the further clotting of the blood, which is a threat of the thrombotic process in the veins and thromboembolism of the arteries of the lungs.
- Chronic ischemia of the lower extremities, since an important stage of laser coagulation is the mandatory use of compression bandages for some time after surgery, which can aggravate ischemia.
- The impossibility of creating the necessary compression after surgery in patients with obesity. The presence of fat accumulations on the hips makes it impossible to use both compression knitwear and elastic bandages.
- Lack of activation of the patient after surgery. It is known that the best way to prevent postoperative complications is to activate the patient. The method of endovasal laser coagulation requires that the patient get up from the operating table on his own and move for a certain time.
- The presence of inflammation in the area of intervention, which can serve as a source of infection.
Operation- endovasal laser coagulation (EVLK), videowhich is necessarily demonstrated in medical schools, occurs as follows: on the patient's skin marking is performed using ultrasonic testing. Then the lower limit of the reflux, which is located at the point of attachment of the large influx, is immediately determined. The second mark is placed on 3-4 cm distally from the first, where the puncture will be performed. Further points of inflow of inflows are noted and varicose extended inflows are marked, regardless of the method of removal.
Endovasal laser coagulation of varicose veins - procedure technique
The technique of carrying out endovasal laser coagulation includes five steps:
- Puncture of the subcutaneous main vein and direct conducting of the light guide.
- Determination of the working area of the fiber.
- The beginning of anesthesia.
- Application of the laser.
- Band application.
Endovasal laser coagulation (EVLK) - postoperative period
After the compression jersey is worn, the patient must walk at least 40 minutes. Round-the-clock compression lasts 5 days. Then only in the daytime about two months. The first scheduled examination with ultrasonic angioscanning takes place on 3 day.
Rarely, more often in patients with low pain threshold, in the first 24 hours after the procedure-endovasal laser coagulation (EVLK) complicationsare rare. There may be soreness in the limb. This pain syndrome is more often associated with an incorrectly put on compression bandage, which squeezes the limb, and not with a postoperative trauma.
Endovasal laser coagulation (EVLK), photopostoperative period of which demonstrate that it is also possible the presence of bruises along the length of the coagulated vein, is the safest procedure for varicose veins. The cause of bruising appearance may be perforation of the vein of the end-of-laser laser coagulation, or in excessive tumescent anesthesia, if the "creeping" infiltrate, because of pressure, tore the subcutaneous tissues.
There is also a feeling of tension in the thigh, a feeling of tension in the vein. Typically, this will take about 1,5 months.
Perhaps a short-term increase in body temperature to subfebrile digits.
Approximately in a fifth of patients, on 4-6 day after endovasal laser coagulation, a sensation along the vein can appear.
Over the last 3 yearsendovasal laser coagulation (EVLK), costwhich is still quite high, has undergone several changes. For example, the most modern laser devices, such as water lasers, have appeared. Another important change
- formation of deep views of phlebologists about the presence of important indications for this technique.Endovasal laser coagulation of varicose veins, reviewsspeak for themselves, has recently become widely known and has earned trust among doctors and patients. Within a few years, a vast experience was accumulated in the use of endovasal laser coagulation to eliminate venous pathology, and new relevant findings were published in all world medical journals on phlebology.
Advantages of classical endovasal laser coagulation:
- no skin incisions
- minimal rehabilitation period
- rare hematomas after surgery
- complete absence of pain. Carrying out local tumescent anesthesia in any case guarantees the presence of motor processes right after the operation so that the patient is already in 60 minutes after the operation -endovenous laser coagulation, videoconfirmation of what is available on the Internet, can leave the clinic quite calmly.
Todayendovenous laser coagulation, costwhich can be found by calling the medical center, is the most safe type of surgery for varicose veins
Endovasal laser coagulation of varicose veins - complications
- the operation is very expensive, for example,endovasal laser coagulation (EVLK) pricewhich in Europe is about 3000 Euro. Of course, unlike Russia, insurance medicine there allows this type of treatment to be accessible to the patient.Endovasal laser coagulation of varicose veins, costwhich prevents many from doing the surgery, could soon become more accessible due to the increased competition of medical institutions offering it.
- a sufficiently long procedure for the use of compression stockings, which is longer than with the classical, standard operation
- 4-5% of cases, according to world studies, lead to the resumption of blood flow through the vein site, which as a result requires a session of sclerotherapy
- the existing limitations on the diameter of the main vein, that is, when performing an ultrasound examination of the patient standing the diameter of the vein should not be more than 1 cm. When a larger diameter 1 cm is detected, the question of using a combined laser technique is decided.
- endovenous laser coagulation of veins, reviewsin the Internet are not yet fully voluminous, so it's hard to believe in such a cloudless result
- operation -endovenous laser coagulation, pricehigh enough, so it is difficult to call it available
Endovenous laser coagulation, photowhich can be viewed on the network, quite painless, safe and simple manipulation. Therefore, the demand for it grows constantly. Every day more and more patients prefer it to classical, outdated methods.
Endovasal laser coagulation (EVLK) отзывы:
Recall of our patient Miriya, 41 year, Moscow region, Krasnogorsk.
Endovenous laser coagulation, reviewswhich I learned beforehand on the Internet - is absolutely painless. In the hospital, I spent half a day, which included the preoperative period, the operation and 30 minutes after. I was satisfied with everything. True it was necessary 2 month to go in spetskolotkah, but it's good that by the summer I took them off. There were only 20 small punctures in the lower part of the leg, now they are no longer visible. The leg does not hurt at all, otherwise the aching leg constantly ached before the operation. Thanks to the head of phlebology, the excellent doctor Alexei Nikolaevich Voloshkin for the good attitude and professional work.Maria, 41 year
The recall of our patient Stanislav, 47 years, Moscow.
My leg was constantly hurting, there was a buzzing sensation in her at the end of the day. The operation was not solved in a classic way, because it was scary after the reviews on the network and possible complications. Before the operation, and I was offered -endovenous laser coagulation, in Moscow,in the medical center of phlebology MIFTS, where I decided to do it, did ultrasound, gave blood and everything. After the operation, they were forced to stand up from the table and walk for about an hour. Three days later I saw a doctor, I was warned that compression stockings should be worn before 3 weeks. I did not worry about the scars, although I am glad that they are no longer visible. Six months passed after the procedure of endovasal laser coagulation. Everything is super. Thanks to all the staff of the phlebology center from doctors to nurses and especially the administrator Tatiana for your attention. Stanislav, 47 years.