The use of endovenous laser treatment (EVLT) to eliminate saphenous and primary tributary reflux offers an alternative approach to the invasive procedure of ligation and stripping. The role of the sonographer includes:
Pre Procedure: Performance of a detailed Duplex Scan of the deep and superficial venous systems to determine origin of reflux. The target vessel is evaluated for size, distance from the skin line, stenotic or aneurysmal segments and sites of prominent incompetent tributaries. EVLT is offered to patients with a relatively straight segment of incompetent saphenous vein with a diameter greater than 5mm.
Day of Procedure: Mapping of the target vessel on the skin followed by application of a topical anaesthetic agent along the course of the vein and DVT exclusion.
During Procedure: Provision of ultrasound guidance for percutaneous vein access, advancement of wires and catheters, correct placement of laser probe and injection of tumescent anaesthesia.
Immediately Post Procedure: Documentation of patency of adjacent major axial vessels.
3-5 Days Post Procedure: Performance of a Duplex Scan to exclude DVT, confirm ablation of treated vein and document any residual varicosities.
Conclusion: The sonographer plays a vital role in endovenous ablation including patient selection, intraoperative ultrasound guidance and follow-up assessment. The degree of involvement may vary between institutions.