Q) Endovenous Laser Ablation (EVLA) of varicose veins is best suited for patients:
A. With needle phobia
B. With thrombophlebitis
C. With excessive tortuosity of the vein
D. With primary varicose veins
Ans d
EVLA is thermal ablation of varicose veins in which laser fiber is inserted in the lumen and ablation is done from inside. It is a good modality for primary and recurrent varicose veins and work in both long and short segments.
This treatment is not effective in cases where there is needle phobia or the veins are having excessive tortuousity or thrombophlebitis. This procedure is done under ultrasound guidance and wire is passed from the superficial to the deep veins.
Tumescent means swollen or distended, typically due to the infiltration of fluid.
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It refers to the injection of a large volume of dilute local anesthetic solution (usually lidocaine with epinephrine and saline) into subcutaneous tissue.
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This causes the tissue to swell or become turgid (tumescent).
In procedures like endovenous thermal ablation:
Tumescent solution:
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Compresses the vein to improve contact with the ablation device.
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Separates the vein from surrounding structures (like nerves or skin).
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Acts as a thermal insulator (heat sink) to prevent collateral damage.
Tumescent local anesthesia also helps
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A. Needle phobia – EVLA requires multiple needle sticks (tumescent anesthesia), making this option inappropriate.
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B. Thrombophlebitis – Active inflammation or thrombosis is a relative contraindication to EVLA.
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C. Excess tortuosity – Makes catheter navigation difficult; EVLA is less suitable.
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D. Primary varicose veins – Ideal candidates, especially with straight vein anatomy and valvular incompetence.