Venous disease of the lower extremity is the most common form of peripheral vascular disease nationwide. Seventy two percent of women over 60 years of age and 40 percent of men over 60 years of age suffer from chronic venous insufficiency. The presence of venous insufficiency leads to the development of leg swelling, varicose veins, spider angiomata, reticular veins, lipodermatosclerosis, and, in the most advanced stages, chronic venous stasis ulceration. The most common symptoms associated with the disease are pain with prolonged periods of dependency, swelling, superficial thrombophlebitis, hemorrhage, and ulceration. Additionally, the cosmetic appearance of venous disease in the limb contributes significantly of overall patient unhappiness and quality of life.
The treatment strategy of venous disease depends upon the pathophysiology of the saphenous and deep veins of the affected limb. When reflux or incompetence within the saphenofemoral segment is detected sonographically, the patient is currently offered endovenous laser therapy, or EVLT, a procedure which replaces saphenous ligation and stripping, and which offers the advantage of being minimally invasive with no requisite incision, higher technical and physiologic success, lower recurrence, lower overall cost, and availability in an office as opposed to a hospital. The procedure involves accessing the saphenous vein under ultrasound and threading a laser fiber along the length of the vein. The laser is then used to cauterize the lining of the vein, resulting in ablation of the lumen. The vast majority of patients require no further therapy for the resolution of their veins, with a small minority requiring manual removal of varicose veins through microphlebectomy.