Endovenous Laser (EVLA)
Endovenous laser. The saphenous vein, closed from inside, in a single ambulatory session.
Endovenous laser ablation (EVLA) at Palazzo Manzoni in Brescia, performed by Prof. Edoardo Cervi and Dr. Fabio Viotti. A thin laser fibre introduced through a needle puncture closes the diseased saphenous trunk from inside the vein. Ambulatory, local anaesthesia, walk out the same day.
Endovenous laser ablation (EVLA, Endovenous Laser Ablation) at Palazzo Manzoni in Brescia is performed by Prof. Edoardo Cervi and Dr. Fabio Viotti. A thin laser fibre is introduced into the diseased vein through a needle puncture under ecocolordoppler control. The vein is then closed thermally along its length. The procedure is ambulatory, performed under local tumescent anaesthesia, typically takes 30 to 60 minutes, and the patient walks out the same day. The classic stripping (safenectomia) has been replaced by this technique for almost every indication.
One needle puncture
No incision, no stripping, no scar.
Local anaesthesia
Tumescent technique, no general or spinal.
Walk out the same day
30 to 60 minutes, then home.
Ecocolordoppler-guided
Real-time control during the closure.
What Brought You Here
The saphenous is the source. The visible vein is the symptom.
You may have been told, more than once, that the vein on your calf or thigh would eventually require surgery. You may have been told that the saphenous vein “had to be stripped.” You may have postponed the conversation for years on the basis of that recommendation alone.
If you’ve reached this page, you have already done the wait. What you need now is the ecocolordoppler. For most patients with confirmed saphenous reflux, the right answer is no longer stripping.
It is endovenous laser ablation: a single needle puncture, a fibre threaded inside the diseased vein, a controlled emission of heat that closes the vessel along its length. Walk in, walk out. The body reabsorbs the closed vein progressively over months.
What Endovenous Laser Actually Does
The laser closes the vein from inside, not from outside
The classic stripping procedure removed the saphenous vein by pulling it out through an incision at the groin and another at the ankle. The operation was effective; the recovery was significant. Endovenous laser does the same job, but without removing the vein. The vessel is closed in place.
The body, over the following months, reabsorbs the closed vein the way it reabsorbs any closed vessel. The closure is thermal. A thin laser fibre is introduced into the vein through a single needle puncture (typically near the knee or the ankle, depending on the segment to be treated).
Local anaesthesia is infiltrated around the vein along its entire length (tumescent anaesthesia: a dilute solution of local anaesthetic, infiltrated under ecocolordoppler control). The laser is then activated and progressively retracted along the vein, depositing controlled heat that seals the vessel wall.
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Closed, not stripped
The vein is sealed in place and reabsorbed by the body, with no incision and no scar.
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One puncture, one session
A single needle puncture under ecocolordoppler control, with the patient walking out the same day.
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Mapped before the laser turns on
The system above and below the treated segment is mapped first, by Prof. Cervi and Dr. Viotti.
How It Works, Step by Step
How an EVLA procedure works, step by step.
Step 01
Examination and ecocolordoppler
A focused phlebological examination and a complete venous ecocolordoppler. The diseased saphenous trunk is identified, the reflux is documented, the length to be treated is measured, and the anatomy is examined for any feature that would modify the technique (junctions, perforators, tributaries).
Step 02
The plan
You leave the first visit with a clear plan: the saphenous segment to be treated by laser, any tributaries that will be addressed by foam sclerotherapy in subsequent sessions, the expected timeline, and the compression and follow-up protocol.
Step 03
The procedure
Ambulatory, at Palazzo Manzoni. The leg is prepared and positioned. Under ecocolordoppler control, a single needle puncture allows the introduction of a thin laser fibre into the diseased vein. Tumescent local anaesthesia is infiltrated along the path of the vein. The laser is activated and progressively retracted. Total procedure time, 30 to 60 minutes for a standard saphenous segment.
Step 04
Compression and immediate return
A class II elasto-compressive stocking is applied at the end of the procedure. Walking begins immediately. Normal activity, including work, from the same day or the next. Strenuous physical activity is reintroduced after the first follow-up.
Who Endovenous Laser Is For
Is endovenous laser
right for your saphenous?
Endovenous laser is the modern answer to saphenous reflux, but it is a specific answer for a specific anatomy. At Palazzo Manzoni, most EVLA candidates share several of the following.
Clinical profile
- Confirmed reflux of the great or small saphenous vein on ecocolordoppler
- Saphenous diameter within the range suitable for endovenous laser (the consultation establishes this precisely)
- Patient who wishes to avoid the classic stripping
- Suitable anatomy of the saphenous trunk (straight enough for the fibre, accessible puncture point)
Combined with foam sclerotherapy
- EVLA addresses the saphenous trunk in a single session
- Foam sclerotherapy typically addresses the residual tributaries and collaterals in subsequent ambulatory sessions, four to six weeks later
- The two techniques are complementary, and most patients benefit from both in the same overall plan
- The visible varicose tributaries fed by the now-closed saphenous typically improve substantially on their own
Where endovenous laser isn’t the right answer?
Endovenous laser is not indicated during pregnancy and immediate postpartum, with active deep venous thrombosis, or with severe peripheral arterial disease. Specific anatomical features can also make the technique unsuitable: a very tortuous saphenous trunk, or very superficial segments where the laser energy would risk skin damage. In these cases, alternatives (radiofrequency, foam sclerotherapy, in selected cases HIFU) are discussed.
If EVLA fits, your ecocolordoppler will confirm it. If not, the right answer for your saphenous still exists, and the assessment will find it.
Why This Replaced Stripping
Stripping is no longer the gold standard
The classic stripping (safenectomia) was the gold standard for decades. It worked: the diseased vein was physically removed, the reflux source was eliminated. The cost was the operation itself (general or spinal anaesthesia, two incisions, recovery measurable in weeks rather than days) and the consequences of “strappamento,” the physical pulling out of the vein along its length.
Endovenous techniques (laser, radiofrequency, in selected cases HIFU) close the vein without removing it. The closure is reliable. The recovery is measured in days. The general anaesthesia is no longer required. The scar is replaced by a needle puncture. For the substantial majority of patients with saphenous reflux, this is now the right first answer. Stripping is reserved for very selected anatomical pictures.
Your Recovery
Day zero, the first weeks, and the months that follow
Day 0
The procedure itself. Walking begins immediately. Compression stocking on. Return home within hours.
Days 1 to 14
Compression stocking worn during the day. The treated leg may feel cord-like along the path of the laser, with mild tightness or pulling. This is the expected response, not a complication. Daily activity from day one. Strenuous physical activity avoided.
Weeks 3 to 6
The treated vein progressively retracts and reabsorbs. The first follow-up ecocolordoppler confirms the closure. Residual tributaries, if any, are addressed in subsequent foam sclerotherapy sessions.
Months 2 to 6
The reabsorption continues. The visible varicose tributaries on the calf or thigh, fed previously by the now-closed saphenous, typically improve substantially on their own; the residual segments are addressed by foam.
Long term
Periodic ecocolordoppler check-ups (typically annual at first, then less frequent) confirm the stability of the closure and identify any new segments of reflux.
Honest Trade-offs
What endovenous laser
doesn’t do
Endovenous laser is a very successful technique, but not a perfect one. The honest picture: the closure is thermal, and a small share of patients experience local pulling or cord-like sensation along the path of the laser for several weeks. This resolves with the reabsorption. Tumescent anaesthesia is well tolerated but does involve a series of small injections along the path of the vein.
A small share of patients develop a brown pigmentation along the treated path. This typically fades over months. Recurrence is possible. With ecocolordoppler-based planning and durable closure of the saphenous segment, recurrence rates are low. New reflux in previously competent segments can develop over time.
The technique is operator-dependent. The competence of the team performing the procedure is one of the main factors in the long-term result. That is why, at Palazzo Manzoni, the same specialists who map the venous system are the ones who perform the closure.
Who Performs Your Treatment
Dr. Fabio Viotti
Phlebology consultation and endovenous laser. Working alongside Prof. Edoardo Cervi on the endovenous laser pathway at Palazzo Manzoni.
Phlebology and endovenous laser
phlebology consultation and endovenous laser ablation of the saphenous trunk
Closure from inside the vein
no stripping, no scars, with the patient walking out the same day
Ecocolordoppler mapping first
the system above and below the treated segment mapped before the laser turns on
Alongside Prof. Edoardo Cervi
part of the vascular and phlebology team, with continuity from first visit through follow-up
“Endovenous laser is a procedure that has been mature for years. What still varies is the precision of the ecocolordoppler mapping that precedes it. The closure of a saphenous trunk in a system that has not been properly mapped is a closure that produces, in time, a different reflux somewhere else. The work is in the map.”
Patient Stories
Other people were told
they needed surgery
Different starting points, the same recommendation they’d been dreading — and a different answer once the ecocolordoppler was done.
In their own words
I’d been told the saphenous had to be stripped, with the operation that goes with it. EVLA was a single puncture, local anaesthesia, walked out the same afternoon. The ecocolordoppler at six months confirmed the closure.
The second pregnancy left the saphenous insufficient. EVLA in the morning, foam sclerotherapy two months later for the residual veins. The legs feel ten years younger.
The vein on the calf had been there for twenty years. Once the ecocolordoppler made it clear that the saphenous was the source, EVLA closed it in one session. The calf vein has faded on its own.
If Endovenous Laser Isn’t Your Answer
If laser isn’t right, another technique usually is
For varicose tributaries and surface veins without significant saphenous reflux, ultrasound-guided foam sclerotherapy is typically the right first answer.
For selected anatomical pictures unsuitable for laser, radiofrequency is discussed. The first consultation establishes which technique fits your venous map.
→Ultrasound-guided foam sclerotherapy
For varicose tributaries and surface veins without significant saphenous reflux, and for residual tributaries after EVLA.
→Radiofrequency
A thermal technique very similar to endovenous laser, with the same indications and a similar recovery profile.
→Vascular consultation
An ecocolordoppler-supported consultation establishes which technique fits your venous map.
Your ecocolordoppler will clarify which technique fits your venous map.
Common Questions
Common questions
about endovenous laser
Is endovenous laser painful?
The procedure is performed under tumescent local anaesthesia. Most patients describe pressure or pulling rather than pain. There is no general or spinal anaesthesia.
How long does the procedure take?
Typically 30 to 60 minutes for a standard saphenous segment, plus preparation and recovery time. Total visit, about half a working day.
When can I return to work?
The same day or the next. Most patients return to office work the day after. Strenuous physical activity is reintroduced after the first follow-up (typically two to three weeks).
Will I have a scar?
A single needle puncture, which heals as a small mark, typically not visible after a few weeks. No surgical incisions.
Will the saphenous vein be removed?
No. The vein is closed in place by the laser. The body progressively reabsorbs the closed vessel over months.
What about radiofrequency?
Radiofrequency is a thermal technique very similar to endovenous laser, with the same indications and a similar recovery profile. The consultation establishes which technique fits your venous map.
Will I still need foam sclerotherapy afterwards?
Most patients benefit from one or more sessions of foam sclerotherapy after the laser, to address the residual tributaries that were previously fed by the now-closed saphenous. The two techniques are complementary, not alternatives.
Can the vein come back after EVLA?
The treated segment, once properly closed and reabsorbed, does not reopen. New reflux can develop in other segments over time. Periodic follow-up ecocolordoppler identifies new reflux early.
Is endovenous laser covered by the national health system?
The cost and the funding pathway are clarified at the consultation. Detailed transparent estimates are provided after the first visit.
Where is Palazzo Manzoni, and do I need a referral?
Istituto Chirurgico Palazzo Manzoni is at Via dei Mille 14 in central Brescia. No referral required.
Who performs the procedure?
Endovenous laser at Palazzo Manzoni is performed by Prof. Edoardo Cervi and Dr. Fabio Viotti.
Take the Next Step
The saphenous vein can be closed in a single afternoon,
and the operation you were dreading doesn’t have to happen.
At Palazzo Manzoni in Brescia, your endovenous laser plan is built around the ecocolordoppler map of your specific venous system.
Address
Via dei Mille 14, 25122 Brescia, Italia
Phone
Hours
Mon-Fri 8:30-18:30 · Sat 9:00-13:00
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Get in touch
Call, email, WhatsApp, or book online.
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Be examined by Prof. Cervi or Dr. Viotti with ecocolordoppler
Specialist mapping and plan in the same visit.
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Move forward, with a plan
A plan that closes the source, not just the symptom.
Content reviewed by Prof. Edoardo Cervi, head of Vascular Surgery.