Will My EVTA Procedures Hurt?

One of the most frequent questions asked is will the procedures hurt. This is often a difficult question to answer, because everyone experiences pain differently. There are some patients that report no pain after the procedure and for some patients the pain can be significant. For the purposes of this discussion we will discuss the average of what most of our patients experience.

The EVTA or laser procedure is usually done on long, large diameter veins. This procedure uses heat to close the vein permanently, however, the heat also causes temporary surrounding tissue damage and this is what causes most of the post-procedure pain. The actual procedure itself is not painful because local anesthesia is used. Most of the time patients say that for about 2 weeks afterwards they experience a sometimes sharp but mostly a dull achy pain. This can be constant for the first week and by the second week the pain reduces daily until it’s gone. Most of our patients can use Tylenol or Ibuprofen for pain but some patient require something stronger.

People often describe a cord like sensation that resembles a pulled muscle. This sensation results from the treated vein shrinking in length and causing a tightness. This can last for 1-2 months sometimes, as the vein is resolving. Patient often become concerned that something will tear or break, but that does not happen and some mild to medium stretching of the leg can help this resolve faster.

One of the side effects of EVTA can be paresthesia or numbness, this usually occurs on the inside of the calf sometimes from the knee down to the ankle. This results from a sensory nerve that is close to the treated vein becoming ablated. The numbness is temporary for most patients but can take several months to resolve. Often while the nerve is repairing itself patients can experience a tingling or burning sensation. There is a small percentage of patients that this numbness never completely resolves in, and they describe a funny sensation while shaving their legs or putting on socks. This does not effect function of the leg at all.

Compression Stockings

In the legs there are deep veins which return 90% of the blood back to the heart and superficial veins which return the remaining 10%. It is the superficial veins that can have valves failure that allow blood to pool in the distal legs, this causes an increased pressure in the legs resulting in increased symptoms including pain with standing or sitting for prolonged periods of time, achiness, heaviness, swelling, cramps at night, edema, skin changes, and ulcerations. The technical name for this is Chronic Venous Insufficiency(CVI).

Compression stocking do exactly what the name implies, namely compression. If you can compress the superficial veins and stop the pooling of blood and force the blood to return the the heart through the deep system, then often time the person experiences a reduction of the symptoms associated with CVI. The big problem with compression stockings are that wearing them is for some patients uncomfortable. Either they are too tight and seem to be pinching in areas or they are simply too hot to wear.

What are Varicose Veins?

Varicose veins are enlarged veins that are swollen and raised above the surface of the skin. They can be dark purple or blue, and look twisted and bulging. Varicose veins are commonly found on the backs of the calves or on the inside of the leg. They develop when valves in the veins that allow blood to flow toward the heart stop working properly. As a result, blood pools in the veins and causes them to get larger. Veins have an estimated prevalence between 5% to 30% in the adult population, with a female to male predominance of 3 to 1. The technical name for varicose veins is Chronic Venous Insufficiency(CVI).

Although the most common manifestations of CVI are dilated veins, such as telangiectases, reticular veins, and varicose veins ,CVI also includes problematic veins that are not visible to the eye causing a condition that is called venous hypertension. Venous hypertension can cause various pathologies including pain with standing or sitting for prolonged periods of time, achiness, heaviness, swelling, cramps at night, edema, skin changes, and ulcerations.

Risk factors found to be associated with CVI include age, sex, a family history of varicose veins, obesity, pregnancy, phlebitis, and previous leg injury. There also may be environmental or behavioral factors associated with CVI such as prolonged standing and perhaps a sitting posture at work. Varicose veins have a significant impact on lifestyles, with millions of people seeking medical attention for their symptomatic and cosmetic problems annually.