About EVLA - Laser Ablation
The circulatory system is made up of both veins and arteries. Arteries deliver fresh oxygen-rich blood from the heart to all tissues and veins then collect the oxygen-depleted blood again and transport it back to the heart.
The heart will pump blood through the arteries, but not all the way through the veins.
In the lower limbs, blood requires a different transport system to return it, against gravity, back to the heart. This transport system is made up of a pump again, the “calf pump” and one way valves within the veins.
It is for this reason that walking is a great way to keep your legs healthy, since the calf pump is activated all the time.
Broken one-way valves in the legs will cause blood to flow back through the vein and pool in the lower legs, this is known as venous reflux, and often presents as varicose veins. Varicose veins are large blue tortuous vessels that bulge from the surface of the skin.
EVLA Procedure
What is endovenous laser ablation?
Endovenous laser ablation, or EVLA, is a minimally invasive treatment for varicose veins caused by superficial venous reflux. A thin laser fibre is passed inside the faulty vein and heat is used to seal it closed from within. Blood then redirects naturally through the healthy veins, and the sealed vein is gradually absorbed by the body.
It is one of two endovenous thermal techniques we use, the other being radiofrequency ablation. Both replace the open stripping operation for most suitable patients, and both are performed in our rooms under local anaesthetic rather than in hospital.
How the procedure works
Before anything is done, Dr Blignaut maps the veins to be treated using duplex ultrasound, so the treatment plan is based on where the reflux actually arises rather than on which veins are visible.
On the day, a small needle is inserted into the vein, usually just below the knee. It is the same calibre as a routine drip needle. The needle is exchanged for a fine plastic cannula, through which the laser fibre is passed up inside the vein under ultrasound guidance.
A dilute mixture of saline and local anaesthetic is then injected around the vein along its length. This is called tumescent anaesthesia, and it does two jobs: it numbs the vein and it forms a protective layer of fluid between the vein and the surrounding tissues and nerves.
The laser is activated and delivers a measured amount of heat energy to the vein wall as the fibre is withdrawn. The collagen in the wall contracts and the vein seals shut. The cannula is removed and a layered bandage applied. The procedure takes 20 to 40 minutes.
Most patients report little or manageable discomfort during the procedure. For anxious or needle phobic patients we can give a mild intravenous sedative before or during it. You leave our rooms once it is complete, and may drive yourself home if no sedation was used.
Who it suits
Endovenous techniques have replaced traditional open surgery for many suitable patients12. The appropriate treatment depends on venous anatomy, reflux pattern, previous treatment and individual clinical circumstances. Open surgery remains appropriate in selected cases.
Patients with superficial venous reflux demonstrated on a duplex scan are generally suitable candidates. Deep venous reflux, usually the result of a previous DVT, may influence whether superficial vein treatment is appropriate and is assessed individually on duplex ultrasound.
Other factors we consider include pregnancy and breastfeeding, a history of deep vein thrombosis, reduced mobility, and any anticoagulant or antiplatelet medication you take. Tell us about all your medication, and do not stop prescribed medication unless instructed to do so by the doctor who prescribed it.
The only way to establish whether laser ablation suits you is a duplex scan performed by a vein specialist.
Your assessment is performed by Dr Johan Blignaut and includes duplex mapping before treatment is recommended. Treatment is selected according to your venous anatomy, not simply according to the veins visible on the skin.
Laser or radiofrequency?
Patients often ask which is better. Both are endovenous thermal techniques, both close the vein with heat, and randomised comparisons and a meta-analysis of 29 studies have found broadly similar closure rates between them4.
There are differences in the detail. Laser delivers energy at a higher peak temperature at the fibre tip, while radiofrequency heats a segment of vein to a controlled temperature along a heating element. Some studies have reported slightly more post-procedure bruising and discomfort in the first week after laser, though this difference narrows with modern fibres and wavelengths34.
Radiofrequency ablation is our most commonly used endovenous treatment. Dr Blignaut uses laser ablation in specific cases where radiofrequency is less suitable, for example in veins of a particular size, depth or configuration. Which technique is used in your case is decided after your duplex scan and discussed with you beforehand.
Recovery
The bandage is removed 24 hours after your procedure, and a compression stocking is then worn as instructed.
Walk every day from the outset. Walking is actively encouraged and helps reduce the risk of clot formation. Avoid strenuous activity, heavy lifting and hot baths for about a week. Most patients resume their normal daily activities within a day or two.
Mild tenderness, bruising and a tight or pulling sensation along the treated vein are common in the first two weeks as the sealed vein contracts. This settles on its own. We review you afterwards, and where further work is needed on surface branches this is usually done at a later session.
Risks and side effects
Endovenous laser ablation is well tolerated, but as with any procedure there are risks worth understanding beforehand.
Common and temporary. Bruising along the treated vein, tenderness, and a tight cord-like sensation as the vein contracts over the following weeks. Numbness or tingling in a small patch of skin can occur where a sensory nerve runs close to the treated vein, and usually resolves.
Less common. Superficial thrombophlebitis in a surface branch, skin discolouration over the treated vein, and infection at a puncture site.
Uncommon. Deep vein thrombosis, and extension of thrombus from the treated vein towards a deep vein junction. Walking regularly and wearing your compression as instructed reduce this risk. Report any new calf swelling, worsening pain, or breathlessness promptly.
Recurrence. Venous disease is progressive. Treatment addresses the reflux present today, but new areas of reflux can develop over time, and some patients need further treatment years later. * Individual results may vary.
Pricing and medical schemes
Funding for vein treatment depends on your medical scheme, your benefit option, the clinical indication for treatment, the specific procedure performed, and your scheme’s authorisation requirements. Because these vary from patient to patient and change from year to year, we do not publish scheme-by-scheme cover.
We submit the authorisation request to your scheme on your behalf. Any estimated shortfall is payable on the day of your procedure. Where authorisation has not been obtained beforehand, payment is required in full and you can then claim from your scheme. If you are not on a medical scheme we will provide you with a detailed written quotation.
For current scheme and pricing information, please see our medical schemes and pricing page, or contact your nearest vein centre and we will check your specific benefits.
EVLA on The Doctors
Venacure video
References
- De Maeseneer MG, Kakkos SK, Aherne T, et al. European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg. 2022;63(2):184–267. ESVS guideline
- Gloviczki P, Lawrence PF, Wasan SM, et al. The 2022 SVS, AVF and AVLS clinical practice guidelines for the management of varicose veins of the lower extremities. Part I. J Vasc Surg Venous Lymphat Disord. 2023;11(2):231–61. Journal
- Almeida JI, Kaufman J, Göckeritz O, et al. Radiofrequency endovenous ClosureFAST versus laser ablation for the treatment of great saphenous reflux: a multicenter, single-blinded, randomized study (RECOVERY study). J Vasc Interv Radiol. 2009;20(6):752–9. Journal
- Wang X, Wang H, Zhang R, et al. Endovenous radiofrequency ablation vs laser ablation in patients with lower extremity varicose veins: a meta-analysis. J Vasc Surg Venous Lymphat Disord. 2024. PubMed 38316290
Not sure which treatment is right for you? See our side-by-side comparison of radiofrequency ablation, EVLA, VenaSeal and foam sclerotherapy, and how the choice is made.
Written and medically reviewed by Dr Johan Blignaut, MBChB (UOFS), FCS(SA), Specialist Surgeon.
Last medically reviewed: August 2026. This page is reviewed periodically and updated when clinical practice changes. It is general information, not medical advice – see our terms and medical disclaimer.