EVLA: Is it the best for your varicose veins?

Laser surgery—formally known as endovenous laser ablation (EVLA) or endovenous laser treatment (EVLT)—is widely considered an effective and minimally invasive option for treating varicose veins. Here's a breakdown of what that means:

Effectiveness

• High success and closure rates - One study reported that after treating 1,000 limbs and following up for up to 60 months, 98% of treated veins remained closed. Another trial showed a 97% clinical success rate, with most leg ulcers healing in 83% of patients. (PubMed)

• Symptom relief and patient satisfaction - Over a year later, 84% of patients reported their symptoms were gone or minimal, and 97% were very or mostly satisfied. (PubMed)

• Studies confirm safety and efficacy - Additional research over 3–6 months also found EVLA to be both safe and effective. (PubMed)

• Endorsed by vascular guidelines - EVLA (or similar endovenous thermal ablation techniques) has become the preferred treatment over traditional surgical stripping, with official guidelines in the U.S. and UK backing its use.

  
  

Safety & Complications

Laser ablation is minimally invasive, typically done under local anesthesia or spinal anethesia, and requires short stay hospitalization.

• Common minor side effects (with approximate rates):

  • Bruising: ~51%

  • Induration (firmness): ~47%

  • Paresthesia (tingling): ~3.8%

  • Phlebitis: ~7.4%

  • Tightness: ~24.8%

• Rare serious complications:

  • Skin burns: ~0.5%

  • Deep vein thrombosis (DVT): ~0.4%

  • Pulmonary embolism: ~0.1%

  • Nerve injury: ~0.8%

• Better safety profile than surgery - Compared to vein stripping, EVLA shows lower rates of severe complications, such as infection and nerve damage.

  
  

Recovery & Convenience

• Quick turnaround: Most patients return to normal activity within a day or two.

• Post-treatment care: Usage of compression stockings for a short period—typically up to two weeks—is common to support recovery.

• Faster recovery than traditional surgery: Patients generally experience less pain and a quicker return to routine after EVLA compared to open surgery.

  
  

Comparing Alternatives

• Foam sclerotherapy vs. laser - In older data (2012), foam sclerotherapy achieved a 69% success rate versus 74% for laser. Foam had less pain and faster activity return but needed more repeat treatments.

• Laser for spider & small veins - For facial spider veins, laser therapy shows high efficacy—78% to 94% of treated veins significantly improved or disappeared.

• Other emerging treatments - Techniques like radiofrequency ablation, mechanochemical ablation, and glue-based closure are also effective. Some evidence suggests radiofrequency may offer better long-term results, but differences are small.

  
  

Summary at a Glance

Feature	Laser (EVLA/EVLT)
Success rate	Very high (≈97–98% closure)
Patient satisfaction	Very high (≈97%)
Recovery time	Rapid—most return in 1–2 days
Minor complications	Common (bruising, tightness, paresthesia)
Major complications	Rare (burns, DVT, nerve injury)
Compared to surgery	Better safety, faster recovery
Against sclerotherapy	Slightly more effective, often single session
Alternatives	Comparable; choice depends on vein type

Takeaway

Endovenous laser ablation is a modern, effective, and safe approach for treating varicose veins, offering excellent outcomes and a quick return to normal life. It generally outperforms traditional surgery and compares favourably with other minimally invasive options.