Using ultrasound as a guide the varicose veins as well as the GSV are traced on the skin with a Sharpie. This is done prior to prepping. Entry point for the Laser fiber insertion is marked.  

The entry to the vein can be either percutaneously with a special needle and sheath or surgically. Most cases are done percutaneously. Here, the GSV is accessed surgically. A loop of the vein is grasped and isolated with the phlebectomy hook and is ready for introduction of the Laser fiber. 

A small slit is made on the vein wall... 

The Laser fiber is introduced into the vein and under ultrasound guidance, the tip is advanced to its juncture with the deep vein at the groin. 

Ultrasound guidance is also used to administer tumescent anesthesia around the entire length of the vein to be treated. 

Ablation has begun and is halfway down the thigh. Laser energy exiting the tip of the fiber is hot and this heat causes the inside walls of the vein to thicken and shrink down and occlude the vein. The red Laser light shinihg through the skin helps in localiization of the tip as it is slowly withdrawn. Incidentally, this red visble light is harmless. The therapeutic laser light is invisible and can damage the retina if exposed directly to the eye. Hence, the need for safety eyewear during the procedure. 

Upon completion, the tip is inspected. A small amount of char material is normal and a sign that the Laser was effective.