• 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 of 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. At The Vein Institute of Toronto™ you will undergo a comprehensive venous consultation by a physician, comprising your venous history and physical exam, followed by a venous duplex ultrasound in order to assess for superficial venous reflux, rule out deep venous thrombosis and map out the anatomy of your superficial venous system. This allows us to develop a personalized treatment plan ideal for you.
2. If you decide to proceed with the procedure, please follow the pre-procedure instructions (page 6) and medication protocol comprised of Arnica™ and Bromelain to minimize post-procedure discomfort and bruising to optimize the results. An EVA kit including Arnica™ tablets/gel, Bromelain tablets and gel pack may be obtained from The Vein Institute of Toronto™.
3. The EVA procedure is performed according to our own tested and proven protocol, which was developed by physicians from around the world (page 7).   EVA is a minimally invasive, ultrasound-guided procedure involving endovenous ablation of the affected saphenous vein.  At The Vein Institute of Toronto™, our EVA protocol using our unique micropuncture technique has produced a 98% technical success rate and 92% clinical success rate in over 2200 procedures to date.
4. After the procedure a physician assistant will assist you to put on the required compression stockings. Please wear the Class II (30-40 mm Hg) compression stockings for the first 72 hours and then from first thing in the morning to before bed time for another 10 days. For optimal results, please follow the post-procedure instructions (page 8).
5. You will be seen in follow-up at six and twelve weeks after the procedure or as per your personal schedule and requirements. At each follow-up, a venous ultrasound will be performed to confirm the treated saphenous vein is closed. Foam sclerotherapy injections (which are included as part of your procedure) will be performed for any residual branch varicose veins (page 9) at your discretion or if clinically necessary. Please bring your stockings for all follow-up appointments. All post EVA follow-ups are included as part of the procedure.
6. At your 6 and 12 week follow-up appointments, you will be instructed on our Leg Wellness Program to improve the conditioning of your legs.

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 shown to reduce pain, bruising and swelling after the EVA procedure.
2. Take one 500 mg Bromelain tablet twice per day, for 3 days prior to the procedure. DO NOT TAKE Bromelain, if you have a Sulfa allergy.
3. Your normal medications may be taken on the morning of your procedure along with a light breakfast. You may eat and drink normally before the procedure. However please avoid alcohol and caffeine containing products.
4. Please do not take blood thinners for 1 week prior to the procedure. Please check with the physician who prescribed your medication to verify that you may discontinue this medication for this period of time. Please inform the physician performing the EVA procedure of any health problems, allergies experienced and/or medication you are currently taking. Tetracycline or Minocin should be discontinued for 10 days before and after the procedure.
5. Wear loose, comfortable clothing that can be worn over the stockings after the procedure. Please bring a warm pair of socks with you to keep your feet warm prior to the procedure. Please do not wear sandals to the procedure.
6. We have a compression stocking service onsite to ensure you are measured and fitted with the correct type and size of stockings. Accurately fitted stockings are essential to ensure the long term success of the procedure.
7. Please read the enclosed post procedure instructions (page 8) prior to your procedure. Please bring your stockings to your follow-up appointments.  Have someone accompany and drive you home after the procedure.

1. Please arrive AT LEAST 30 MINUTES before your procedure time, to allow for proper preparation before the procedure. On arrival, you will be asked to change into a procedure gown and remove your trousers or shorts leaving your undergarments and socks on.
2. A local anesthetic cream will be applied to the area to be treated. This should be applied at least 30 minutes before your procedure to maximize effectiveness. You will also be given an oral sedative (Ativan) and pain killer (Oxycodone) at your discretion to minimize discomfort during the procedure.
3. A pre-treatment photograph will be taken for to act as a baseline for your chart. A repeat mapping venous ultrasound will be performed. A tourniquet will be applied to your leg, in a standing position.
4. You will then lie down on the treatment table and a cleaning solution will be applied on the leg(s) to create a sterile field for treatment. Sterile drapes will be placed around the treatment area (All materials used are sterile and disposed after single use).
5. Local anesthetic (“freezing”) will be injected at the vein entry site. A needle is placed through the skin using ultrasound guidance into the vein to be treated. At The Vein Institute of Toronto™ we utilize a unique micropuncture technique to maximize success and minimize your discomfort. A guidewire will be placed through the needle into the vein. You may feel mild discomfort as the wire is being positioned. A vascular sheath (tube) will be placed over the guidewire and positioned at the junction of the superficial and deep venous system using ultrasound guidance. The ablation device will be placed through the sheath to the correct position.
6. Branch vein sclerotherapy for your enlarged varicose veins will also be performed at the same sittingwith foam Sotadecrol solution under light or ultrasound guidance.
7. Tumescent anesthetic using a special mechanical pump, will be applied around the vein, to increase the effectiveness of the thermal ablation, and minimize your discomfort (only for laser or radiofrequency). The ablation device is then activated and pulled back along the vein. The ablation device is activated for a period of approximately 5 minutes. For the safety of patients and staff, we utilize and fully adhere to ablation safety protocols. After the catheter is removed, a small antibiotic dressing is placed on the skin, in order to prevent infection and promote healing.
8. Immediately after the treatment, dressings and support stockings will be applied to the treated area on your leg(s). We suggest you walk for five minutes after the procedure, before leaving the clinic to promote deep venous circulation.

1. Keep support hose and Comprilan bandage on for the first 72 hours continuously.   After the first 72 hours please wear the stockings and Comprilan bandage from the first thing in the morning (after a short 10 minute shower), until bedtime at night for another ten days. If bleeding occurs from the puncture site, apply pressure for five minutes. Remove the gauze dressing/bandages on your leg 72 hours following the procedure.
2. You can resume daily activities the same day of the procedure (excluding exercise).  You can resume exercising in two days (no weights, sit-ups or pushups for 2 weeks after the procedure). We strongly encourage walking at least 30 minutes per day from the day of the procedure for two weeks. You can shower immediately after the procedure (if you wear a leg bag) but no hot baths, hot tub, Jacuzzi, sauna or tanning for 2 weeks after the procedure.
3. Bruising, localized swelling, some tenderness, tightness and pain are normal along the inner thigh or behind the calf after treatment.  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 and part of the normal healing process. Apply a gel pack (part of EVA kit) three times daily and Arnica Gel™ twice per day from day 3 to 7 after the procedure to reduce the bruising. From day 7 to 14 after the procedure, please apply warm compresses to the bruised and lumpy areas. Redness, tenderness and swelling around the point of entry may remain longer than 2 weeks. If you have pain and leg swelling involving the entire leg or calf, please call our office or send an e-mail immediately.
4. To Prevent Pain, Bruising & Persistent Discolouration
   1. Please continue to take 5 pellets of Arnica™, 3 times per day and one 500mg  Bromelain tablet twice per day for 11 days after the procedure in order to reduce pain, swelling and bruising. Also, drink atleast 2 liters of water per day to promote healing, reduce bruising and prevent discolouration/pigmentation.
   2. Elevate your leg on a couch or chair and please apply gel pack for 10 minutes at a time three times daily to the bruised and painful areas from day 3 to day 7 after the procedure. Then apply a warm compress to the bruised/painful or lumpy areas from day 7 to 14 after the procedure.  After each application of the gel pack or warm compress, apply Arnica Gel™ to the bruised areas.
   3. Please purchase generic Ibuprofen tablets (not Advil™) and take 600 mg three times daily orally for seven days after the procedure date. Ibuprofen may be purchased at any pharmacy.
   4. It is essential to avoid sun exposure after the procedure. It is mandatory to apply a strong sunblock SPF 40 to 50 (available here) at sites of bruising or discolouration if there is any sun exposure.

1. Do not shave your legs or apply cream for one day prior to and the day of your follow-up appointments. No tanning within two weeks of the treatment date. Do not take Tetracycline or Minocin 10 days before or after sclerotherapy. Eat a snack one hour prior to your treatment. Bring shorts to wear during the procedure and slacks to wear out of the office. Sclerotherapy will only be performed if necessary.

1. Keep stockings on continuously for the first 72 hours. Only take off stockings to go to the washroom or for showers. After the first 72 hours 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 routine). Compression stockings help decrease bruising at the sclerotherapy sites.
2. To Prevent Pain, Bruising & Persistent Discolouration
   1. Please take 5 pellets of Arnica™, 3 times per day and one 500mg  Bromelain tablet twice per day for 11 days after the procedure in order to reduce pain, swelling and bruising. Also, drink atleast 2 liters of water per day to promote healing, reduce bruising and prevent discolouration or pigmentation.
   2. Elevate your leg on a couch or chair and please apply gel pack for 10 minutes at a time three times daily to the bruised and painful areas from day 3 to day 7 after the procedure. Then apply a warm compress to the bruised/painful or lumpy areas from day 7 to 14 after the procedure.  After each application of the gel pack or warm compress, apply Arnica Gel™ to the bruised areas.
   3. Please purchase generic Ibuprofen tablets (not Advil™) and take 600 mg three times daily orally for seven days after the procedure date. Ibuprofen may be purchased at any pharmacy.
   4. It is critical to avoid sun exposure after sclerotherapy. It is mandatory to apply a strong sunblock SPF 40 to 50 (available here) at sites of bruising or discolouration if there is any sun exposure.
3. You can resume normal daily activities excluding exercise today. You can resume exercising in 2 days. You can shower in the morning but no weight lifting, sit-ups, push-ups, hot baths, hot tub, sauna and jacuzzi for 2 weeks after sclerotherapy.
4. Bruising, local swelling, areas of bumpiness, lumps and some tenderness are normal after treatment, but please feel free to call the office if you have any questions or concerns.
5. You will not notice an immediate improvement.  Clearance of varicose veins and discolouration usually occurs over a 4-12 week period and in some cases may take longer.

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 Great Saphenous Vein Treatments and on the posterior calf for the Small 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 will usually produce a good response.

Call 416-929-0834 for a Complimentary Physician Consultation