Twenty Years' Experience with Endovenous Laser Ablation for Varicose Veins: A Critical Appraisal of the Original Procedure.

Objective: A critical appraisal of the original procedure of endovenous laser ablation (EVLA) for varicose veins.

Method: Evaluation of all practical aspects of the procedure.

Results: EVLA procedures are performed in a strictly ambulatory setting with tumescent local anesthesia (TLA). Technical improvements have resulted in the need for fewer incisions and re-punctures, less ecchymosis, and fewer technical failures. Administration of an appropriate amount of TLA via an infusion pump has reduced the risk of nerve injury, administration time, and pain during the procedure. Use of a 1470-nm diode laser and a radial fiber have significantly improved patient satisfaction and reduced the occurrence of complications such as pain, tightness, ecchymosis, and the need for additional procedures. Lastly, there are only a few indications left for high ligation and stripping.

Conclusion: Over the past 20 years, EVLA has evolved into an effective, cost-efficient, and safe procedure that provides high patient satisfaction.