Dr Navarro has retired and now refers patients to his Protese Dr Al-Misky. Click here for details.

212-888-8688 | 800-300-VEIN | 212-249-6117

910 Fifth Avenue (cross street: 72nd) New York, NY 10021

Endovenous Laser Ablation

Endovenous Laser Ablation (EVLA), also referred to as Endolaser or EVLT, is an endovenous laser treatment performed in the office as a minimally invasive method for treating large varicose veins. Developed and patented by Dr. A-Misky's mentor, Dr. Luis Navarro, EVLA uses existing laser and ultrasound technology to close the main vein from the inside with laser energy. EVLA makes costly hospitalizations, large incisions, and the need for general anesthesia completely unnecessary while also limiting patient downtime for recovery.

 

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What to Expect During Treatment

On the day of the surgery, the patient will apply a topical numbing cream given to them by the VTC about two hours ahead of the appointment. The home application of the numbing cream allows the patient to avoid idly sitting in the doctor’s office for an hour or more, waiting for the anesthetic cream to become fully active. After the two hour numbing period is complete and the patient has arrived at the VTC office, Dr Al-Misky will do a leg marking. This will provide a ‘map’ on the skin, showing on the body’s surface where the ultrasound visualization has shown where the problem vein and important ancillary veins are under the surface. Dr Al-Misky then makes an injection of a local anesthetic under the skin, which is almost painless as the numbing cream has desensitized the tissue.

In a sterile setting, the patient is placed on the table. Another dose of local anesthesia, this time near the veins themselves, is injected under color duplex ultrasound guidance. Then the surgery begins as a minute laser fiber is inserted directly into the vein through a catheter (tiny tube) as a needle punctures the skin (no surgery scalpel needed). Pulses of laser energy are released along the course of the vein to seal it completely. Once the laser has sealed the vein, the fiber is removed and a steri-strip closes the entry point. Patients who need a Mini-Phlebectomy treatment for the smaller branches will usually have it performed at this time. When the procedure is complete, the leg is wrapped with elastic bandages.

Post instructions are reviewed with the patient, then the patient can walk out of the office and return to their normal daily routine, usually without any pain medication (about 15% of our patients take Advil or Tylenol if they feel any mild discomfort). Our office staff will usually text you that evening to make sure that you are comfortable and that everything is going according to plan.

Post Treatment

You wear the bandages until your Post-Op visit the next day. Then your leg is unwrapped and examined. You will be slightly bruised; this bruising usually fades away across 2 to 3 weeks. Some people feel tightness in the area of the treated vein indicating that the vein is healing- OTC pain medication can alleviate symptoms. Follow-up sclerotherapy may be needed for any remaining small spider veins and can be done at this Post-Op visit.

This endovenous laser treatment is a safe and effective treatment for large varicose veins, specifically approved by the FDA in 2002 for treatment of greater saphenous vein reflux. Hundreds of thousands of cases treated successfully worldwide since its creation. Endolaser has an overall success rate greater than 97%. These results are better than those of traditional surgery in both the short term and long term.

EVLT & Other Advanced Treatments

For EVLT and other advanced treatments, be prepared to block out 1-2 hours during your appointment visit. Keep in mind that you will be asked to come back to the office the next day for a follow-up appointment.

The patient’s leg(s) will be wrapped for the night. You can return to your daily activities, but are advised not to exercise for two full days. Dr. Al-Misky will remove the bandages on the check-up visit. If sclerotherapy is needed to address smaller veins, it is often done at this appointment. Dr. Al-Misky will provide a prescription for compression stockings; these are usually needed for only a few days after the surgery.

Patients should avoid sun (sunlight can cause bruising to become worse) until the bruising has subsided. If you are planning on being outdoors, cover your legs and apply SPF 50 or higher if you are showing skin. The bruising can be covered with makeup if needed.

Why we prefer EVLT to Radio Frequency

Some vein doctors close the main problem veins with heat from a radio frequency source instead of EVLA. Local anesthesia with sedation is required for this procedure. Some doctors may prefer this modality as the insurance reimbursement rates can be higher than for procedures with EVLA. We have found that the success rate is not as high with radio frequency as it is with EVLA, and the rate of complications is higher. Therefore, we use EVLA instead.

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The Vein Treatment Center
910 Fifth Avenue
Ground Floor (cross street: 72nd)
New York, NY 10021

212-888-8688

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Before and After

before after pictures large varicose veins treatment legs-24

EVLT, Mini-Phlebectomy & Sclerotherapy | Male | 57 yrs old
Vein: Varicose

Before and After pic leg varicose vein EVLT Mini Phlebectomy

EVLT & Mini-Phlebectomy | Female | 53 yrs old
Vein: Varicose

before after pictures varicose vein leg treatment

EVLT & Mini-Phlebectomy | Female | 41 yrs old
Vein: Varicose

before after pictures varicose veins treatment legs-27

EVLT & Mini-Phlebectomy | Female | 46 yrs old
Vein: Varicose

Patient Reviews

I've been seeing Dr. Al-Misky for vein removal treatments for over 10 years, and I can't say enough good things about her. She is an expert in her field, and she has succeeded in keeping my spider and varicose veins at bay. I never feel rushed during any of my appointments, and she spends as much time as needed with me. She has a pleasant demeanor, and her office is clean and comfortable. If I ever call with a question or leave a message, she is quick to respond. I will never go anywhere else for vein removal. I love Dr. Al-Misky!

D. Bossotti


I have been a patient of Dr. Al-Misky for 5 years and I couldn't be happier with the results! She helped me get rid of my varicose veins as well as my spider veins. She is a gifted doctor who makes you feel so comfortable and relaxed. The office is clean and cheerful. Dr. Al-Misky and her assistant, Doreena, are so pleasant and friendly; you feel like you're with old friends. I actually looked forward to my visits. She truly cares about ensuring her patients get the best results possible!

Monique