21st Century Varicose Vein Treatment

Varicose vein treatment has come a long way in the past 15 years, with new understanding of the underlying causes, development of new treatment techniques using cutting edge technology, and the successful introduction of these into regular medical practice

Varicose veins

Varicose veins are stretched veins under the skin. They are due to the failure of the venous valves to propel used/exhausted blood back to heart from the tissues of the legs and body. When standing upright, the resulting column of blood from the heart down to the feet exerts enormous pressure within the veins.

They hurt when stretched, are felt as a generalised heaviness and aching of the legs as the day progresses, and are relieved when the body is lying flat, e.g. when sleeping.

As they stretch, the veins become visible protruding lumps, most often on the inside of the calves.


Eventually, the failure of the veins to clear away the used blood from the tissues, damages the skin around the ankles. The skin becomes dry, scaly and itchy. It darkens, thins and may ultimately breakdown completely, causing an ulcer (open sore) that won’t heal.


“Strip surgery”

Treatment used to be surgical under general anaesthetic, with cutting at the groins to tear out (“strip”) affected veins. This was painful with a six-week recovery period and a high rate of recurrence (up to 40 percent at five years). Women were advised to “wait until their child-bearing years were over” and ulcers—untreatable surgically because of the risk of infection—were managed by regular tight bandaging, sometimes for years.

Duplex scanning

EVLA appeared in the early 2000’s by combining developments in ultrasound imaging and medical laser therapy. The new ultrasound imaging (duplex scanning) allowed thorough examination of the varicose vein pathways of the legs, leading to a greater understanding of the condition. Causes of (surgical) treatment failure and recurrence became all too clear when veins could be directly visualized, guiding more precise and effective treatment.

Pelvic varicose veins (“Congestion”)

Veins coming from the pelvis showed that varicose veins not only occur in the legs, but in the abdomen and pelvis too. These pelvic veins are the cause of pregnancy-related vein problems (vaginal varices and haemorrhoids) and can cause chronic pelvic pain in women and testicular varicocele in men. These discoveries have led to new understanding and effective treatments of these troubling disorders—e.g. pelvic and varicocele embolization, and variceal sclerotherapy.

Laser treatment (EVLA) of leg varicose veins

EVLA is a Daycase procedure under local anaesthetic. Infra red Diode Laser technology guided by ultrasound imaging allows the affected veins to be precisely identified, and a thin laser fibre (600microns wide) to be advanced painlessly through the vein via a hypodermic needle puncture, just below the knee. The activated tip of the laser fibre shrinks the varicose vein, causing it close irreversibly.

This is the same process as the shrinkage of a steak when cooked on a barbeque. (Think of a vein as a tiny cylinder of steak!)

The patient walks out after a one-hour recovery and returns to full mobility in 24 hours.

The natural healing process of the body removes the treated vein over the next few weeks, but the symptomatic benefit is felt within 24 hours, with the relief of pressure from the affected leg.


Thanks to the improved diagnosis with duplex ultrasound, and the precise image-guided laser treatment of EVLA, the treatment results have inevitably improved. 98 percent of treatment has been successful across all centres around the world, over the past 15 years.

The two percent relates to the small risk of new venous problems in the future, as varicose veins are a genetic condition passed through families and causing the underlying weakness of the vein walls and valves. Over time, new vein failure may occur due to this underlying inherited tendency to varicose veins. EVLA treatment can be seen as resetting the ticking clock to zero, if you will.

Evidence and safety

Thanks, in part, to robust governance structures such as the National Institute of Clinical Excellence (See NICE Varicose vein guidelines IG168), there have been many game-changing advances in modern healthcare. Endovenous Laser Ablation (EVLA) for varicose veins is certainly one these.

With up to 30 percent of the population troubled to some extent by varicose veins and related disorders, EVLA provides the modern, clinically proven, low risk /high benefit treatment that is also affordable, even when not available on the NHS.

Visit https://www.royalfreehadleywood.com/treatments/endovenous-laser-therapy-evlt/ for more information.

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