Endovenous laser ablation (EVLA) in Canberra

What is endovenous laser ablation?

Most varicose veins are fed by a trunk vein running up the inside of the thigh or the back of the calf whose valves have stopped working. EVLA treats that vein. Rather than removing it, the vein is sealed from inside with heat from a laser fibre, then left in place for the body to absorb. Blood that used to pool in it takes the deep veins instead, which is where it should have been going all along.

International guidelines recommend endovenous thermal ablation as the first-line treatment for a refluxing trunk vein, ahead of surgical stripping, because the results are comparable and recovery is quicker. CVLM uses a TGA-registered 1470 nm diode laser (neoV) with a radial fibre, which emits energy sideways in a ring so the vein wall is heated evenly rather than at a single point.

Who this is for

EVLA is considered when a duplex ultrasound shows a refluxing trunk vein that is straight enough for a fibre to pass along it, and you have symptoms, skin changes, or a history of phlebitis, ulcer or bleeding that make treatment worthwhile. Typical candidates have aching or heavy legs at the end of the day, ankle swelling, or visible varicose veins that have started to bother them.

It is not the right tool for every vein. Tortuous branch veins, small veins and the varicose veins that remain after the trunk is closed are usually treated with ultrasound-guided sclerotherapy, often in the same plan. If your deep veins are blocked, or you are pregnant, EVLA is deferred. Whether it suits you is decided at your assessment, not from this page.

What happens at your appointment

Your consultation and your treatment are separate visits, with a cooling-off period of about a week between them.

At the consultation, Dr Lapenga takes your history, examines your legs standing and performs a duplex ultrasound in the same room. You leave with the findings explained and a written plan that names the vein to be treated, the fee, and the alternatives.

On the day of treatment, allow around an hour and a half. This is what happens, in order.

1. Mapping. You lie on the couch and the vein is scanned again and marked on the skin with a pen, from where the fibre will enter to where the treatment will finish, just short of the junction with the deep vein.

2. Access. A small area of skin, usually around the knee, is numbed with local anaesthetic. A needle enters the vein under ultrasound guidance and a fine sheath is threaded in. The fibre passes through the sheath and up the vein, and its tip is checked on the screen so it sits exactly where it should.

3. Tumescent anaesthetic. A dilute local anaesthetic is placed around the outside of the vein along its whole length, through a series of small injections guided by ultrasound. This does three jobs at once: it numbs the vein, it squeezes the vein down onto the fibre, and it forms a cushion of fluid that keeps heat away from the skin and nerves. It is the part of the procedure most people notice, as a feeling of pressure and a few sharp stings.

4. Ablation. Everyone in the room puts on laser eye protection. The laser is switched on and the fibre is withdrawn slowly and steadily, a few millimetres a second. As it moves, the vein wall behind it heats, contracts and seals. You may feel warmth or a pulling sensation; pain is not expected, and if you feel any the fibre is paused and more anaesthetic is placed. The ablation itself takes a few minutes.

5. Check and dress. The closed vein is checked on ultrasound and so is the deep vein beside it. The access point is closed with a small dressing; there are no stitches. A compression stocking goes on over the leg.

6. Walk out. You get up, walk around the room, and then walk out. A ten-minute walk immediately afterwards and daily walking from then on are part of the treatment.

Any remaining branch veins are usually treated with sclerotherapy at a later visit, once the leg has settled and the ultrasound shows what is left.

Recovery and what can go wrong

Most people return to desk work the day after EVLA. The stocking is worn for the period stated in your plan, walking is encouraged, and heavy exercise, long flights and hot baths are avoided for a short time. Bruising along the thigh, a tight or pulling feeling along the treated vein and a firm cord under the skin are all normal for one to three weeks and ease with walking and over-the-counter pain relief. A review with ultrasound is booked in the weeks after treatment.

Complications are uncommon but real. They include: phlebitis (a tender, inflamed segment of vein); patches of skin numbness where a nearby nerve has been irritated, which usually resolve over months but occasionally persist; skin burn or discolouration over the vein; infection at the access point; and, rarely, a clot extending into the deep vein, which is why the deep vein is checked and why walking matters. A treated vein can reopen over time, and new varicose veins can form from other veins in later years. Outcomes vary between people, and Dr Lapenga will go through the risks that apply to you before you sign a consent form.

Cost and Medicare

NeoLaser EVLA at CVLM is $3,200 for one leg or $5,400 for both legs, current as at September 2026. Where treatment is clinically indicated and eligibility criteria are met, the Medicare rebate is $542.90 per leg for one saphenous vein (item 32520) or $845.00 per leg where the great and small saphenous veins are both treated (item 32522), leaving $2,657.10 or $2,355.00 out-of-pocket for one leg. Ultrasound-guided sclerotherapy planned alongside it is $800 per session. Your written plan lists what you need, the rebate and your out-of-pocket.

A Medicare rebate applies where treatment is clinically indicated and eligibility criteria are met. Your assessment determines this before any treatment is planned. Clinically indicated means symptoms or skin changes together with ultrasound evidence of reflux. Treatment for appearance alone does not attract a rebate. EVLA is performed in our rooms rather than in hospital, so hospital cover through a health fund does not usually apply. A pay-later option is available through Medipay. See the fees page for the full schedule and what a consultation includes.

Who you will see

Dr Alex Lapenga, Specialist General Practitioner with a fellowship of the College of Phlebology (UK), performs your assessment, your ultrasound and your EVLA himself, and has published peer-reviewed research on endovenous laser technique. Canberra Vein & Laser Medicine is at The Woden Suites, Level 3, Francis Chambers, 40 Corinna Street, Phillip ACT 2606. Phone (02) 5119 3136.

View the supplied surgical vein-removal photograph