Except for a few, most patient of varicose veins problem can definitely go for the laser solution. However there may be some for whom foam sclerotherapy is more suitable.
Firstly an ultrasound scan is performed and the veins are demarcated with a pen. The leg in concern is cleaned nicely and covered in drapes before the patient is made to lie on a couch. The patient can face downward or backward depending upon the veins that require treatment. The steps are observed and guided with the aid of ultrasound scanning.
The doctor would now get inside the vein. A very minute amount of anaesthetic is injected along with a needle which is inserted into the vein. Through the needle a wire is passed up in the concerned vein. Over the wire a catheter is passed after the removal of the needle.
Through the tubing of catheter a laser fibre is made to pass in such a way so that the tip is present at the top most point which requires heating (most appropriate is the crease of the groin). Through an arrangement of multiple tiny needle pricks, large amounts of local anaesthetic solution is injected around the vein.
During the procedure the patient as well as medical staff are expected to wear safety devices like specs for precuation. The process of firing laser and pulling down the vein does not take more than 5 minutes. Sufficient amount of thermal energy is generated to the wall of the vein to induce occlusion, fibrosis and eventually resulting in the disappearance of the vein. Small amount of blood gets heated in the vein, apart from that some heating may occur due to the absorption of photon from the radiation incident on the vein.
Diode lasers are commonly used having a range of wavelengths. Lower wavelengths are haemoglobin specific including 810 n,, 940 nm,980 nm and 1064nm. Water specific higher wavelengths include 1320nm and 1470nm. Post procedure symptoms are expected to be low with higher wavelength lasers at lower power settings.
The patient can hear a warning buzzer and may also smell a burning odour or even taste it, but there will be no pain associated with it. If both the legs are supposed to be treated then one after the other is done. The laser and catheter is then gradually removed. The puncture created by the needle is covered with a dressing. The total treatment may not last more than half an hour.
The treatment may be followed by some foam sclerotherapy or some sort of avulsions may also be undertaken. After all this a compression stocking is put on the patient’s leg.