Micro-EVLA – Micro-Endovenous laser ablation of bulging temporal and periorbital facial veins – a report of a new technique.

Aims:Prominent or bulging veins on the temples or around the eyes can have an adverse impact on a patient’s confidence and quality of life. When small and superficial, these can be treated successfully with transdermal laser. However, when this fails, sclerotherapy or phlebectomy, which are the usual alternatives, can be associated with risks or poor results. This technical note aims to report the use of our micro-EVLA (micro-endovenous laser ablation) technique to treat such veins.Technical Report: The patient was placed in a Trendelenburg position in a warm room. The veins were identified visually and checked with duplex ultrasound. Each section of vein to be treated was cannulated with a 22G intravenous cannula. A 272µm bare fibre was passed into each vein in turn. Local anaesthetic with a vasoconstrictor was injected around the vein, and the patient was placed in a reverse Trendelenburg position. Cold air was used to protect the skin from burns. All vein segments were successfully ablated using 1940nm laser at 2W, with a pull-back of 5 sec/cm. There were no clinical complications. Initially, the veins became hard to touch, but by 6 weeks later, they had almost completely gone. Conclusion: Micro-EVLA appears to be a viable option for the treatment of prominent, bulging veins of the temples and around the eyes. The principles should hold for small superficial veins elsewhere in the body.