• Aching or burning in the legs
• Pain in the legs
• Swelling of the legs or ankles
• Leg cramps or sores
• Itching of the skin around a vein
• Eczema of the skin typically in the calf region
• Open wounds such as skin ulcers around the ankle

• Heredity
• Pregnancy
• Hormonal factors
• Being overweight
• Standing or sitting for long periods of time
• Advancing age
• Injury

• Upon coming to our office you will begin by filling our own developed confidential patient venous questionnaire
• You will then undergo a personal consultation with our Medical Director Dr. Sanjoy Kundu
• He will review your venous questionnaire to focus on the most important findings and symptoms to you
• You will then undergo a focussed venous physical examination to map out all your varicose and spider veins
• Dr. Kundu will then personally perform a venous ultrasound examining your superficial and deep venous system
• A personalized treatment plan will then be presented to you with the different treatment options

The key benefits of EVLT:

• Immediate relief from symptoms
• No scars
• Only a local anesthetic is needed
• Can be performed in the doctor's office (no hospitalization needed)
• Treatment in less than an hour
• Normal activities can be resumed immediately - with little or no pain

1. Each patient undergoes a personal physician consultation as outlined above.
2. On the day of the procedure, the patient undergoes application of local anesthetic spray and cream to the area to be treated to minimize discomfort.
3. The patient undergoes a mapping ultrasound by Dr. Kundu before the procedure to confirm the patient’s anatomy and area to be treated to decrease procedure time and note any changes from the time of the patient’s consultation.
4. Utilizing Dr. Kundu’s unique micropuncture technique, the vein to be treated is accessed and a plastic tube enclosing the laser probe is inserted. We then select a the laser appropriate for each individual patient.
5. Dr. Kundu ensures correct positioning of the laser probe using the ultrasound as a guide to ensure complete and accurate treatment.
6. We then apply tumescent anesthesia around the vein to ensure effective action of the laser and minimize patient discomfort.
7. After the procedure is completed one our knowledgeable staff will help the patient apply the medical compression stockings. Dr. Kundu will then personally review the post-procedure instructions with you.
8. The patient is then entered into our post-procedure protocol (see below) to ensure the vein treated by the laser has been effectively closed and that the branch varicose veins are appropriately treated by either foam sclerotherapy or microphlebectomy.
9. Each patient is able to walk out after the procedure and return to work within two days depending on the type of occupation.

1. All patients at The Vein Institute of Toronto™ will undergo a comprehensive venous consultation including a focussed venous history and physical exam, followed by a duplex ultrasound to document venous (great or small saphenous vein) reflux, rule out deep venous thrombosis and map out the superficial venous system.
2. If the patient decides to proceed with the procedure, they should follow the pre-procedure medication protocol comprised of Arnica™ and Toradol™. A EVLA kit including Arnica™ tablets/gel, gel pack and prescription for other optional medications may be obtained from The Vein Institute of Toronto™.
3. The EVLA procedure is performed with the patient in a supine position for the great saphenous vein, and in a prone position for the small saphenous vein. The procedure takes approximately 45 minutes to perform for one leg and is performed under local anesthesia. At The Vein Institute of Toronto™ we utilize a unique micropuncture technique to perform the EVLA procedure which has produced a 98% technical success rate.
4. After the procedure a dressing is applied to the venous puncture site, and a physician assistant will assist the patient to put on the compression stockings. Patients should wear the Class II (30-40 mm Hg ) compression stockings continuously for the first 72 hours, and then from first thing in the morning to before bed time at night for another 10 days.
5. All patients will be followed up at six and twelve weeks with a venous ultrasound to confirm the great or small saphenous vein is occluded along with foam sclerotherapy injections for any residual varicose veins. Patients should bring their stockings for all follow-up appointments.
6. At your 6 and 12 week follow-up appointments, you will be given the option of entering into our Leg Wellness Program to prevent future leg veins.

1. Take 5 pellets of Arnica™, 3 times per day, for 5 days prior to the procedure. Place pellets under the tongue and allow them to dissolve in your mouth. Arnica™ is a homeopathic medicine which has been proven to reduce pain, bruising and swelling after the procedure. Also take one 10 mg tablet of Toradol™ 3 hours prior to your procedure to minimize discomfort during the procedure (as per your prescription).
2. Your normal medications may be taken on the morning of your procedure along with a light breakfast.
3. You should refrain from using any type of blood thinner for 10 days prior to your procedure, please check with the physician who prescribed your medication to verify that you may discontinue this medication for this period of time.
4. Please inform the doctor involved with the procedure of any health problems, allergies and/or medication you are currently taking.
5. Wear loose, comfortable clothing that will be easy to put on after the procedure. Please bring a warm pair of socks with you to keep your feet warm prior to the procedure. Please remove your socks, trousers and shorts prior to surgery leaving your undergarments on.
6. It is recommended to have two pairs of compression stockings for after the procedure and alternate the two pairs of stockings daily to prevent tears, loss of elasticity and permit washing. We have a compression stocking service onsite to ensure you are measured and fitted with the correct type of stockings. Accurately fitted stockings are essential to ensure success of the procedure.
7. Please read the enclosed post procedure instructions prior to your procedure. Follow-up appointments are required at 6 and 12 weeks post-procedure. Please bring your stockings to your follow-up appointments. All sclerotherapy injections for varicose veins are included as part of the procedure and will be performed at the follow-up appointments.

1. Keep support hose on for the first 72 hours continuously.   After that wear the stockings from the first thing in the morning (ideally, take a quick 5 min shower and then put them on before doing the rest of your morning ritual), until bedtime at night for ten days.
2. You can resume day to day activities today (excluding exercise).  You can resume exercising in two weeks (no weights for 3 weeks after the procedure). Walking or light treadmill can be performed from the day after the procedure. You can shower tomorrow morning but no hot baths, hot tub or sauna for 2 weeks.
3. If bleeding occurs from the puncture site, apply pressure for five minutes. Remove the gauze on your leg the day following the procedure.
4. Please continue to take 5 pellets of Arnica™, 3 times per day for 11 days after the procedure to reduce pain, swelling and bruising. Allow the pellets to dissolve in your mouth.
5. Bruising, local swelling, some tenderness and pain are normal along the inner thigh or behind the calf after treatment, but please feel free to call the office if you have any questions.  Bruising may occur the same or following day. In most cases it will be gone after 2 weeks but could remain longer. You may develop “lumpy” areas in your groin which are tender. These are areas of normal healing. Applying a gel pack (part of EVLA kit) three times daily helps reduce the bruising. Apply Arnica Gel™ twice per day (in the morning and before going to bed) for two weeks after the procedure. Apply Pro-Derm™ Hydrogel to the treated area once a day (mid-day). Hydrogel™ and Arnica Gel™ are available in our office.  Redness and swelling around the point of entry along with tenderness may also remain longer than 2 weeks.
6. To Prevent Pain & Bruising:
   1. Elevate your leg and please apply gel pack three times daily to the bruised, painful area.
   2. Please purchase generic Ibuprofen tablets (not Advil™) and take 600 mg three times daily orally for five days after the procedure date. If you have an allergy to Ibuprofen, please call our office. Ibuprofen may be purchased at any pharmacy.
   3. If you have severe pain, unresponsive to the above measures: Please take one to two Percocet tablets every six hours (as per your prescription). Do not Percocet within 8 hours of the procedure.

1. Do not shave your legs for one day prior to your appointment.
2. Take 5 pellets of Arnica™, 3 times per day, for 2 days prior to the follow-up/sclerotherapy appointment. Place pellets under the tongue and allow them to dissolve in your mouth.
3. Eat a snack one hour prior to your treatment.
4. Bring shorts to wear during the procedure and slacks to wear out of the office.

1. Keep stockings on for 72 hours. Only take off stockings to go to the washroom or showers. Then wear your stockings from morning to night for another 7 days  (ideally, take a quick 5 min shower and then put them on before doing the rest of your morning ritual). This is to decrease bruising at the sclerotherapy sites.
2. Please continue to take 5 pellets of Arnica™, 3 times per day for 11 days after the procedure to reduce pain, swelling and bruising. Allow the pellets to dissolve in your mouth.
3. You can resume normal daily activities excluding exercise today.
4. You can resume exercising in 7 days.
5. You can shower in the morning but no hot baths, hot tub, sauna for 1 week.
6. Bruising, local swelling and some tenderness are normal after treatment, but please feel free to call the office if you have any questions.
7. Use sunscreen SPF 60 for at least 2 weeks following procedure if there is any sun exposure. It is recommended to keep the treated are out of the sun for atleast two weeks.
8. Apply Arnica Gel™  to treatment area twice per day to prevent dehydration.
9. If there is swelling, wrap ice in a cloth and apply to the affected area.
10. You will not notice an immediate improvement.  Clearance usually occurs over a 2-week period and in some cases may take up to 10 weeks.

1. Q. How much and where can the bruising occur after the procedure?
   
   A. The bruising can be quite marked (black and blue) for two weeks along the inner thigh for Greater Saphenous Vein Treatments and on the posterior calf for Lesser Saphenous Vein Treatments. This is normal.

2. Q. Where does the pain occur and what does it feel like?
   
   A. The initial pain immediately after the procedure will be like a aching pain along the inner thigh for Greater Saphenous Vein Treatments and on the posterior calf and behind the knee for Lesser Saphenous Vein Treatments.
   
   B. After the first week you will experience a tightening inside the leg along the inner thigh for Greater Saphenous Vein Treatments and on the posterior calf and behind the knee for Lesser Saphenous Vein Treatments. All of the above are normal.
   
   C. You may also experience a transient numbness or loss of sensation in the treated area which is also normal.

1. Q. What is used for sclerotherapy?
   
   A. We use a foam solution comprised of Sotadecrol, which has been  used for over 30 years.

2. Q. What will I experience after sclerotherapy?
   
   A. You will feel tender hard lumpy areas after sclerotherapy for up to   four weeks which is a sign of normal healing, and a good response.

Call 416-929-0834 for a Complimentary Physician Consultation