Ask Northbrook Vein Specialist Dr. Rosen: Endovenous Laser Treatment

As a board-certified vein specialist, I am part of a group of vein experts that is asked to field questions from the general public in an online forum. Recently a patient asked the following fantastic question:  “How do I know it’s the right time to have vein ablation treatment?”

The patient visited a different vein specialist, received an ultrasound and was told that she had problems with the flow in one of her saphenous veins. Her doctor recommended solving this problem by permanently sealing the malfunctioning vein shut with a laser; this would allow flow to reroute instantly to other, properly functioning, veins in the area. 

To understand more about superficial venous disease, click HERE

To learn more about Endovenous Laser Ablation click HERE

The answer to her question brings up some really fundamentally important points that I think can apply to any decision-making you have to do about ANY medical care you will ever need.

Important Point #1: You are the President of your body.

In my practice, I tell all of my patients that they are the “President” of their bodies. I’m here…all doctors are here…first and foremost…to be the best advisors we can be to help patients make the best decisions they can make for themselves. To do so, patients need to understand the benefits and certainly the potential risks involved with any medical treatment because (here comes important point #2:

Important Point #2: Every medical procedure involves a Risk/Benefit Ratio.

When I say “every” procedure, I mean it. When you take an aspirin for that headache, you have to weigh the benefit of pain relief with the increased risk (for 5 days!) of bleeding from taking that 1 pill. In general, we all try to make decisions where the potential benefits outweigh the risks as much as possible, right?!

That is certainly true when it comes to vein treatments.

In my practice, I take my role of Advisor to the President very seriously. I spend a LOT of time teaching patients about their disease (which is a big part of why I spend a full hour with each new patient). Once I’ve diagnosed the underlying issues they have, I spend a LOT of time explaining the procedures I recommend…why I recommend them over other alternatives…and the Risks/Benefits that are associated with that procedure.

So…I can lay out all of the information about risks/benefits for you in a really understandable way…but you are probably still wondering how you can make your decision in the easiest way possible. That leads to…

Important Point #3: Rosen’s Rule For Making Medical Decisions

If you are unconscious or confused and you are taken to an ER…no worries…doctors will make the best decisions possible for you. But if you are “with it” and you have some time to consider things, consider the following points:
  • Amount of trouble the problem is causing you: Does it affect your daily life? Is it affecting your work? Is it affecting your emotions? Is it preventing you from doing things you would love to do?
  • The acuity of the problem: Is it an emergency and needs to be addressed NOW? Is it urgent but needs to be addressed soon? Is it chronic and may lead to bigger problems later if unaddressed?
  • The effectiveness of the solution: Is it a temporary vs a permanent solution? How likely are the results permanent?


In general, Rosen’s Rule states: The more emergent a problem…the more the problem is affecting you in the short and long term…the more permanent the solution option…the more sense it makes to take on the potential risks involved.

So let’s take this back to that patient’s question regarding Endovenous Laser Treatment.

The underlying problem that EVLT seeks to treat is superficial venous insufficiency (SVI)…wrong-way flow in important, but typically superfluous veins; veins that your body can live without if need be. The spectrum of issues that SVI can lead to ranges from absolutely nothing visible at the surface, yet annoying symptoms that impact daily life…to spider veins….varicose veins…leg swelling…and ultimately to chronic inflammatory changes in the skin of the legs that can lead to skin breakdown and ulceration.

Each patient knows exactly where they lie on that spectrum. For some, the “aesthetic” concerns don’t matter as much as the very aggravating symptoms. For others who are symptomatic, the “aesthetic” concerns have an equally severe impact on their life to the extent that they limit the things they would love to do…the clothes they wear…intimacy…etc.


I can’t tell you what to feel…but I am here to validate your feelings. It is equally important for your enjoyment of this precious, limited lifespan that we are given…for you to feel better both physically and emotionally.

I am also here to do what I can to improve the quality of your life. For those with SVI, Endovenous Laser Treatment has been shown in studies to do just that. It is a permanent solution to SVI in the particular vein segments you treat. It is effective about 97% of the time.

What about the risks with EVLT? Well, fortunately all of them are low. Very low.

This, of course, assumes that the doctor is selecting the best candidates for the procedure. Better candidates are those without other signficant illnesses…don’t have underlying immune issues…don’t have increased underlying risks of making blood clots or have bleeding disorders…are mobile, active people…are people who can wear compression stockings…people who don’t plan to travel, especially long trips, in the immediate future.

You can see that AGE wasn’t one of the things that factored into my decision making on what makes for a good candidate. Age is just a number, and I don’t get all wrapped up in that. Neither should you.

So…assuming a patient is a good candidate, the risks with EVLT are low because it:

  • Is minimally invasive – Teeny paper-cut sized wound that doesn’t require stitches to close.
  • Is performed as a sterile procedure. You get cleaned up. I get cleaned up. Sterile supplies. Low risk of infection.
  • Is done under ultrasound-guidance. Every step of the way I’m watching everything I do live via ultrasound. I know exactly what I’m doing and where I’m doing it. More importantly I can see where the DEEP veins are and can stay far enough away from them to decrease the risk of creating a deep vein clot. The risk of that is very low. So low, I can easily count how many I’ve encountered in the many procedures I’ve performed over the years: ZERO, thank G-d. Also thank the professors who taught me and the years of training I put in to get here and the clever people who devised such safe modes of treatment.
  • Utilizes only local anesthetic: There’s no sedation needed (or wanted) to make you sleepy/goofy. It’s VERY well tolerated. The local anesthetic not only prevents patients from feeling anything during the laser closure, but the dilute numbing fluid also acts to absorb the heat coming off the laser and decreases the risk of heat affecting the tissues in the area around the vein that’s being treated.

OK…so let’s apply Rosen’s Rule to Endovenous laser treatment:

  • The solution is permanent 97% of the time.
  • SVI is rarely emergent. Its more or less urgent depending on the patient.
  • The risks are all low, assuming the patient is a good candidate.
  • The procedure is well-tolerated. Ironically the only discomfort associated with it is when patients get local anesthetic…after which they feel no discomfort at all.

I then kick it back to the patient.

Given all the info I’ve given you, does this problem have enough impact on your life that you are willing to assume the low risk for the highly-likely permanent solution?

Most patients answer “yes”.

It’s just not my place to answer that FOR them.

If you answer “yes”, then NOW is the right time to have your chronic,nagging vein issues evaluated and treated.

If patients still have questions, I do everything I can to answer them as thoroughly, clearly and simply as I can.

If patients want to consider the matter some more, I fit them with compression stockings, teach them tips and tricks on how to use them effectively and tell them to wear them in the meanwhile. They are NOT a permanent fix…more of a “band-aid”…but often help to alleviate symptoms significantly until permanent solutions are performed. I give my patients my email/cell phone number and tell them to shoot me questions. A patient that asks questions is invested in the process of their care…and that’s awesome!

The patient who asked the above question that led to this whole discussion not only benefitted themselves by asking, but I hope that my answer will also help you, Madame or Mister President, make the best decision for your body that you can make.

If NOW is the right time for you, call 847-272-8346 and schedule your initial, 1 hour consultation appointment with me.

I look forward to meeting you and helping your legs to feel and look better than they have in years.

See you soon!