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Endovenous Laser Therapy (EVLT) for Varicose Veins

Laser for Varicose Veins or EVLT (Endovenous Laser Therapy)

Endovenous Laser Therapy (EVLT) is a minimally invasive procedure for the treatment of varicose veins.

It is done in the comfort of our facility.

This procedure is performed to seal the diseased saphenous veins with heat generated by the laser.

This allow your other veins to function normally again.

We also perform radiofrequency ablation of the saphenous veins to help treat varicose veins.

The laser or radiofrequency procedure usually takes less than thirty minutes in most cases with minimal or no discomfort.

Compared to traditional vein surgery:

  • There is no cutting.
  • There are no scars.
  • The EVLT procedure is simpler.
  • General anesthesia is not required.
  • It is performed in an outpatient setting.
  • Recovery to normal activities is quick.
  • The EVLT procedure is more cost effective.
  • It has a significantly lower risks of complications.
  • There is an immediate reduction of symptoms and improvement in appearance.

The Varicose Vein Laser Revolution

Treatment of leg vein disorders has changed dramatically in the past few years.

Modern advances in the treatment of varicose veins include a number of minimally invasive procedures, perhaps the most important being laser and radio frequency.

These elegant new technologies to eliminate troublesome surface veins have almost completely replaced conventional “stripping” and the need for large incisions. Laser has virtually transformed the treatment of varicose veins.

EVLT is an elegant minimally invasive technique performed under local anesthesia and ultrasound guidance in an outpatient setting.

EVLT involves a tiny skin nick just large enough to allow the introduction of a sterile guide wire and laser fiber.

Laser energy is then delivered directly inside the vein to close the saphenous or “root” vein completely.

Laser energy is applied to the inside of the vein. Afterwards, the vein collapses and is absorbed by your body.

Endovenous laser therapy eliminates varicose veins from the inside out. It protects the skin.  Older lasers shot the laser energy through the skin.

There are absolutely no scars and no stitches with this procedure. That is unlike the old stripping operation which usually required general anesthesia and frequently a hospital stay.

The clinical results are excellent.

This technique allows patients to resume normal activity right away.

Laser treatments are also very quick. It often takes less than 30 minutes and the laser is usually only fired for a total of two to three minutes.

Your circulation is improved by removing these abnormal bulging veins resulting in the relief of symptoms and the improved appearance of your legs.

Dr. Happel was the first surgeon in the Pittsburgh area to perform this laser treatment for the removal of painful varicose veins.

Reports with the laser technique to eradicate varicose veins are extremely favorable and have yielded impressive long-term results.

What Causes Varicose Veins?

Varicose veins are usually caused by a weakened saphenous vein.

The saphenous vein that runs the length of the inner leg or down the back of the calf.  Valves in the vein become weak. That allows blood to flow backwards toward the foot and pool.

Later, blood vessels close to the surface of the skin begin to branch out and become enlarge. They can appear twisted and ropey. They bulge out.

The symptoms that accompany varicose veins are aching and heaviness resulting from increased venous pressure.

Before Endovenous Laser Treatment or EVLT was available, the traditional treatment for varicose veins was stripping (ripping out) the diseased vein.

The post-operative risks of stripping included unsightly scarring, inflammation, prolonged pain, and post-operative infection.

The obvious advantages of EVLT over stripping are lower risks because of the elimination of the risks of general anesthesia, the elimination of the potential surgical complications and a much quicker recovery period.

Treatment of varicose veins improves circulation and eliminates the discomfort and suffering.

With the EVLT procedure, there is an immediate improvement in the appearance.

Patients can now have their varicose veins treated in an outpatient setting in less than an hour and then walk home after endovenous laser therapy.

The Happel Laser & Vein Centre can also provide a combined approach should your condition require it.

Insurance coverage varies from plan to plan.  Our office will be happy to assist you with insurance or any other questions you may have.

Common Questions About EVLT and Varicose Veins

What would happen if I left my varicose veins alone and did nothing at all?

Treatment helps to relieve symptoms. If left untreated, these veins can lead to a number of complications including:

  • Phlebitis – which is caused by a blood clot within the varicose vein. The area becomes hot, red, tender, swollen and hard from the superficial blood clot.
  • Ulceration of the skin – is usually very painful and requires months to heal.
  • Venous stasis dermatitis – a permanent brown discoloration of your skin around the ankle.
  • Bleeding – usually significant blood loss that sometimes requires an emergency room visit.

Will elimination of my varicose veins and spider veins adversely affect my circulation?

When varicose veins or spider veins are treated, the healthy veins take over and reroute the blood.

Your circulation is not hurt by the treatment of these veins. In fact, most of the blood that passes through the veins in your legs is carried by the deep veins.

After treatment, will new varicose veins appear?

While recurrence is unlikely for the veins that have actually been treated, new veins may recur in different locations.

That means that many patients treated with EVLT should not be bothered with the same symptomatic varicose veins.

What is the cause of varicose veins?

A weakened saphenous vein usually causes varicose veins.

The saphenous vein is the usually the vein that can be thought of as the “root” of the problem.

Valves in this vein become weakened. This allows blood to flow backwards toward the foot.

Blood pools in the weakened branches. These branches are the actual varicose veins.

What is the main advantages of EVLT over the surgical approach?

The procedure is less invasive, more cost effective and is believed by most doctors to have a lower risk of complications.

What is the recovery period like after EVLT?

There is an immediate reduction of symptoms within a matter of days. The benefits are long lasting.

Should I consider the EVLT procedure for the treatment of varicose veins?

Treatment of varicose veins improves your circulation.

It eliminates the discomfort, heaviness and pain for many patients suffering from this condition.

What are the advantages of EVLT over the traditional surgical approach?

The procedure is simpler, more cost effective and has significantly lower risks of complications and a much quicker recovery period.

How long is the recovery period following EVLT?

With the EVLT procedure, patients can resume normal activity immediately.

There is an immediate reduction of symptoms and within a matter of days the improvement in appearance will be remarkable.

What anesthesia will be required for the EVLT procedure?

The procedure is performed in an outpatient setting in our accredited vein center under local anesthesia.

Will my health insurance plan cover the procedure?

Most health insurance plans cover EVLT. Call us for details regarding your individual health plan.

Don’t I need the veins that are lasered?

Laser treatments of the saphenous veins cause the vein to close.

Later, they will seal and become absorbed. People usually ask at this point in their initial consultation, “Don’t I need that vein?”

“Will getting rid of the saphenous vein mess up my circulation”?

The answer is no, it will not.

We used to strip or remove the saphenous vein without any adverse effects at all on your circulation before the year 2000.

In addition, this vein is sometimes removed for heart bypasses. If weakened from venous insufficiency, heart surgeons cannot use it anyway.

The larger and more important deeper veins, take over and your circulation is improved.

All of the veins in your legs are interconnected. It is a vast network.

Abnormal veins on the surface of the skin can be easily sacrificed. Blood is rerouted through the connections in the network that already exist. You don’t have to make new veins.

There is no problem in sacrificing a diseased vein where the blood is flowing in the wrong direction.

Blood is easily rerouted through connections that already exist.

The result is that your circulation is improved.

The laser heats the blood inside of only your saphenous vein and coagulates it.

What happens to the varicose veins coming off of the saphenous vein?

  • Some may decrease in size.
  • Some may appear the same.
  • Usually your legs will feel better after the laser treatment of the saphenous vein.

Why Stripping of Veins is No Longer Performed?

The Problems with Stripping Varicose Veins:

  • Pain
  • Infections
  • Longer Recovery
  • Scars
  • Risky General Anesthesia
  • Hospitalization
  • Higher Rate of Complications
  • Higher Recurrence Rate
  • Long Hospital Stay
  • Expensive Anesthesia Bill

Clinical Results of Laser Vs. Foam Sclerotherapy

Researchers also found that successful treatment of the great saphenous vein occurred in 83 percent of those who received the laser treatment and 84 percent of the participants who underwent traditional surgery.  These numbers were significantly higher than the 54 percent who had their saphenous vein treated from the foam treatment.

This study appeared in the New England Journal of Medicine.

Dr. Kevin McMullen, a vascular surgeon at the Surgical Hospital of Oklahoma said “Laser is preferred over surgery or foam due to higher success rates with the least amount of complications. Laser therapy works better than foam on larger veins, as the success rates for foam treatments worsens with increasing vein size”, Dr. McMullen said.

Insurance for EVLT (Endovenous Laser Therapy)

Most insurance companies require that you have tried conservative medical management before any definitive treatment is even considered.

That means the heavy, hot and difficult to pull up medical grade compression support stockings.

This requirement for a medical trial of compression support stockings is not supported by doctors who treat venous disease. The best medical evidence and consensus papers by the leading vein experts and the scientific vein literature do not support conservative medical management first.

Nonetheless, insurance companies refuse to pay for treatment of your varicose veins unless you have worn these heavy compression support stockings for over three months.

It is ridiculous.

Will Insurance Cover All of Your Varicose Vein Treatment Cost?

If you want your varicose veins removed, you must know the basics of your plan because not all health insurance plans are equal.

At the very least, you must know what your deductible is just like with your car insurance and with your home insurance.

What is Co-Insurance?

Understand what co-insurance is.

Many plans pay 80%, which means you will be responsible for the remaining 20% of the final bill.

Know that your co-pay and your co-insurance are two different things.

Don’t let your total cost after insurance has picked up their part surprise you after you have your varicose vein procedure done.

Higher Deductible Health Insurance Plans are on the Rise

Employers are changing to cheaper health plans with higher deductibles.

Employers are switching to cheaper plans at a faster rate.

The costs of procedures that are covered by insurance are being shifted to you. It is not uncommon to speak with people who have had their health insurance provided by their employer but have never used it before.

Some people believe that they have “good insurance”.

It is very rare that everything will be covered 100%.

When the medical bills start coming in after the procedure, anger and confusion can follow if you don’t completely understand what your insurance plan actually covers.

Because a doctor or a billing department tells you that your procedure is a covered service mistakenly implies to some that you will not get a bill.

Some people believe that because it is approved by their insurance and it is covered that they will owe nothing after their procedure.

This is usually not true.

If you have a deductible and a co-insurance, you will get a bill.

Make sure that the doctor and the facility providing your varicose vein procedure is in-network.

If the doctor and the vein center do not participate with your plan (has not signed a contract with your insurance plan), you will pay more out-of-pocket.

Insurance Coverage for Laser Treatment of Varicose Veins

The trend is for less and less coverage for varicose veins. Insurance companies are cracking down. If your veins are cosmetic, they are not covered.

Insurance companies often refuse to cover what your doctor feels is best for you. The insurance companies are determining medical necessity.

Not the doctors.

It has become a financial decision.

We are seeing more and more denial letters from insurance companies.

The trend is for insurance companies to limit vein care as much as possible and cut costs.


The gift of laser and radiofrequency varicose vein technologies is like the gift of fire.

The power for its good has to be tempered with its destructive power. In untrained hands, these great minimally invasive technologies can do much harm.

In a trained vascular surgeon’s hand who specializes in varicose veins, the sky is the limit.

Choose your vein doctor at least as carefully as you would a new car, a TV, your child’s college, or even a new restaurant in town.

This innovative laser technique started a medical revolution in the treatment of varicose veins.

EVLT allows patients to resume normal activity quickly with virtually no discomfort or scarring.

The EVLT procedure is simple, quick, cost effective, and has a lower risk of complications than traditional surgery.

All lasers for varicose vein treatment are not the same.

When we researched the perfect lasers, we were like the people on the beach with their metal detectors looking for treasure.

We found them.

Our goal is to provide each patient with and personal approach to their individual vein problem. We also use radiofrequency closure for the treatment of saphenous veins. The laser and radiofrequency options give us the tools to individualize the best treatment for each patient.

Dr. Happel is the most credentialed and experienced vein specialist for the treatment of varicose veins in Pittsburgh. He has performed thousands of endovenous laser and radio frequency ablation procedures for the treatment of varicose veins — the most of any vein doctor in the region that we serve.

Dr. Happel himself (not a staff member or any type of assistant) will determine whether your veins are cosmetic or medical. He will teach you why you have varicose veins in the first place. We never delegate the diagnosis or treatment of any part of your care to ancillary staff.

Dr. Happel is a board certified, fellowship trained vascular surgeon from the Mayo Clinic. There is no higher qualification in the country for treating varicose veins.

Dr. Happel said. “I became interested in endovenous laser procedures during my post- residency fellowship training at the Mayo Clinic. “At that time, surgical ligation and stripping was the standard of care for varicose veins. Laser and radiofrequency has completely changed the dynamic as to how we approach modern vein care.”

We are proud that the Happel Laser and Vein Center has the distinct honor of being voted the best varicose vein center in Pittsburgh. But we continue to strive to make you happy and endeavor to exceed your expectations.

We accept the following insurances:


  • Aetna
  • Anthem/BCBS
  • Cigna
  • Coventry
  • Devon
  • 4Most
  • Health America
  • Health Assurance
  • Health Plan of Upper Ohio Valley
  • Humana
  • Highmark/BCBS
  • Medical Mutual
  • Mon-Valley Health Plan
  • Multi-Plan
  • Tricare
  • United Health Care
  • UPMC
  • All BC/BS plans