Endovenous laser therapy (EVLT) for varicose veins: how does it work?

Written by: Mr Alastair Lewis
Edited by: Aoife Maguire

EVLT has emerged as the gold standard for treating the primary veins associated with varicose vein development, supplanting older, less effective surgical techniques like vein stripping. Unlike surgical methods, EVLT is swift and straightforward, conducted under local anaesthesia without the need for hospitalisation or general anaesthesia.


Here to explain more about the procedure is leading minimally invasive venous surgeon Mr Alastair Lewis.



Endovenous laser therapy (EVLT) is:


  • Swift: Typically lasting between 30 to 45 minutes.
  • Convenient: No prolonged hospital stays are necessary, with normal activities resuming immediately.
  • Effective: Success rates exceeding 95%, often with immediate symptom relief.
  • Minimally Invasive: No surgical incisions are required.


EVLT treatment procedure:


All EVLT procedures are outpatient, walk-in, walk-out affairs. With ultrasound guidance, a small cannula is inserted into the target vein, and a thin laser fibre is threaded inside, gently heating and destroying the vein wall. Local anaesthesia numbs the area, and any visible varicose veins are usually treated simultaneously with foam injections. Patients can resume normal activities right after treatment, though compression stockings and mobility are recommended for 1 to 2 weeks.


Suitable veins for EVLT:


EVLT targets the deeper main veins in the leg, which cause visible varicose veins. However, it's not suitable for superficial veins or tortuous veins close to the skin. Typically, a combination of EVLT and foam sclerotherapy achieves the best cosmetic outcome.


Unsuitable veins for EVLT:


Veins close to the skin or those with tortuous paths aren't suitable for EVLT and are usually treated with foam sclerotherapy instead.


Comparison with radiofrequency ablation (RFA):


While RFA is simpler, EVLT is preferred by experienced practitioners for its versatility and fine-tuning capabilities, akin to professional photographers opting for more complex cameras. If your specialist can't perform EVLT, they may not offer the full range of modern varicose vein treatments.




If you would like to book a consultation with Mr Lewis, do not hesitate to do so by visiting his Top Doctors profile today.

By Mr Alastair Lewis
Vascular surgery

Mr Alastair Lewis is a leading minimally invasive venous surgeon who specialises exclusively in the treatment of varicose veins. He works in full time private practice mainly based in Belfast and Dublin as well as attending Ballykelly and Hillsborough. He is an expert in the non-surgical management of varicose veins and thread veins with EVLT, radiofrequency ablation of veins, foam sclerotherapy and microsclerotherapy. He is a fully trained and accredited in venous ultrasound. He practises privately at Kingsbridge Private Hospital Belfast, the Fitzwilliam Clinic and Hillsborough Private Clinic as well as Kingsbridge Private Hospital North West, and The Vein Clinic at The Beacon Hospital, Dublin.

Mr Lewis is one of a small number of full-time varicose vein practitioners in the UK and Ireland and the only one working in Northern Ireland. He was appointed as a consultant vascular surgeon to the Southern Health and Social Care Trust in 2007 and played a central role establishing the regional varicose vein service in Northern Ireland.

He enjoys a national reputation as an authority in the management of all aspects of venous disease has been invited to speak on the expert management of varicose veins at the Royal Society of Medicine’s Venous Forum, The British Association of Sclerotherapists and Vascular Society of Great Britain and Ireland meetings on a regular basis in recent years. He has been a member of the board of The British Association of Sclerotherapists since 2021. He holds the prestigious Diploma in Venous Disease from the European Society of Phlebology.

He offers keyhole treatments for thread veins, varicose veins and complications of chronic venous insufficiency. Treatments offered include endogenous laser ablation, foam sclerotherapy, microsclerotherapy and non-injectable treatment of facial veins. He has significant experience in the treatment of veins on the face, chest, hands, feet and in the management of pelvic venous disorders.

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