A small incision is made to the side of the vein and a slender tube with a light source is aimed from behind the vessel. The light illuminates the vein. Then, a mixture of saline, lidocaine and epinephrine are injected into the vein. The solution “plumps up” the vein for more visibility. Once the correct vein is identified, another tiny incision is made into the skin.
The surgeon inserts a modified (filed) crochet hook through the incision and places the hook over the vein. The vein is pulled through the incision and grasped with a tiny clamp. Then, with gentle rotation and pulling the vein “snaps” free from its attachments and is pulled completely through the skin. The light source behind the vein helps the surgeon to ensure all of the affected section is removed. Further incisions are made, as necessary, to access more of the vein, or other veins.
As a last step, the saline mixture is injected into the remaining ends of the vein. This flushes remaining blood from the target vessel and causes the vein to collapse, reducing the risk of bleeding and bruising. Finally, all the instruments are removed. The incisions are so tiny there is no need for sutures.
After surgery, a compression dressing is placed over the treated site. Patients typically go home an hour later and are told to keep their legs elevated for at least 48 hours.
Peter Lawrence, M.D., a Vascular Surgeon at the David Geffen School of Medicine at UCLA, has been using LASP for several years. The procedure may be used by itself or combined with other treatments.
A follow-up study of more than 250 patients found there were few complications or a low rate of recurrence. Months after the surgery, patients are often unable to find any signs of scarring. Traditional methods to remove varicose veins are not always completely successful. In up to 40 percent of cases, doctors miss some of the affected vein or fail to completely remove the vessel, leading to a recurrence.
With LASP, Lawrence says he can be much more certain he has corrected the problem. Currently, LASP is only available at UCLA Medical Center. However, Lawrence expects to teach others about the technique starting in the fall.