What is endovenous laser ablation for venous insufficiency?
When the venous system is working properly, blood from the great saphenous veins drains one way into the deep veins at the level of the groin into the saphenofemoral junction and into the common femoral veins and up to the heart. Similarly, venous blood in the small saphenous vein drains into the deep veins, namely the popliteal vein which is a continuation of the femoral vein at the level of the knee. Also, venuos blood goes through the perforator veins into the deep veins at the level of the foot, ankle, lower leg, mid leg, behind the knee, lower thigh, mid thigh and upper thigh … The netire system works in harmony and venous harmony means that there is egress of blood out of the lower extremities on a continuous basis. This harmony is assited by breathing and the negative pressure it creates in the chest, essentially ‘sucking’ blood out of the lower extremities. It is also aided by movement and this is where it is important to help this mechanism by developing and maintaining a strong calf muscle pump.
Of course, things get complicated and work inefficiently when the vein valves malfunction, as is the case with venous insufficiency. In this case, the vein valves in the superficial veins can leak causing varicose veins. This causes localized pooling of blood in the superficial veins. This is technically called segmental venous reflux.
When the valves at major junctions of the superficial veins leak, these conditions are called saphenofemoral and saphenopoliteal reflux. These conditions are generally treated with vein stripping, which is not recommended or performed much in the current era. They are also treated with newer technologies, called venous ablation. Venous ablation procedures are performed using radiofrequency energy (VNUS Closure), laser energy (EVLT Laser), mechanochemical techniques (ClariVein procedure), or the very newly FDA cleared procedures called VenaSeal (chemical glue) or Varithena (chemical Polidochanol foam).
Hratch L Karamanoukian MD FACS RVT RPVI RPhS