VARICOSE & SPIDER VEINS
WHAT ARE VARICOSE VEINS? >
A varicose vein is a vein that has become larger, more visible and more tortuous (wiggly) than normal. Varicose veins are a common condition affecting nearly 25% of the population at some stage in their life. Varicose veins can occur in teenage years but are more common with advancing age and they tend to get worse over time. In women, they often appear first in pregnancy, and further pregnancies may make them worse. As a rule, varicose veins do not go away spontaneously although, if they occur first in pregnancy, they will often improve to some extent once baby has been born. The majority of people with varicose veins will have no single obvious cause. However, varicose veins tend to run in families and they're slightly more common in men than women (although many believe the opposite). They're also more common in people who are overweight and in people with occupations that involve prolonged standing such as hairdressers (and surgeons!).
There is no single “best” treatment for varicose veins. It is very important to be wary of “specialists” that claim that any one type of vein treatment is better than any other. It is simply not true. All forms of treatment have their place. The best treatment depends on many factors, including the type, size and position of the veins and individual patient preference and requirements and budget. In particular, some treatments cost much more than others but the outcomes may differ only slightly. Many “specialists” offering varicose vein treatments are not vascular surgeons and can offer only a limited number of procedures for veins. They will always suggest that the treatments they can provide are “best”. If your vascular “specialist” says that varicose vein stripping is barbaric or out dated – ask him or her if they are actually able to perform that procedure and the answer will be “no”.
Dr Bond is a specialist vascular surgeon with specific interest in treating varicose veins. He is trained in all the treatment methods and is not biased towards any one or the other. Consequently, he is able to offer you the most appropriate choice for your varicose veins. All patients receive a full consultation and examination to determine which treatment is best suited in their case depending upon cost, required speed of recovery, preferred aesthetic and best outcome. Unlike many clinics that insist you pay for an ultrasound scan before you even see the doctor, at VASC, an ultrasound is performed only if found to be required during the consultation.
For further reading and more information about Varicose Veins please click the button below to download our information booklet.
TYPES OF VARICOSE VEINS >
Spider Veins (Telangectasia)
Spider veins (Telangectasia) are small, hair-like blue- red lines that form web like shapes on legs. They may occur alone or along with larger “true” varicose veins. They are particularly common in women, occur at all ages and may increase over time. They may start following episodes of bruising or injury or following pregnancy but often have no apparent cause at all. They may occasionally occur or increase after treatment for larger veins. They are best treated with sclerotherapy injections.
Reticular veins are veins that are dark blue veins between 1mm and 3mm in size. They are often very close to the skin and can be raised or flat. Reticular veins commonly co-exist with both telangectasia and "true" varicose veins. Like Spider veins, when they are present without "true " varicose veins they are often best treated with sclerotherapy injections or occasionally by local surgical removal. Depending on their extent, Medicare rebate may be available for their treatment.
"True" Varicose Veins
These are veins greater than 3mm in diameter. They are the classical bulging veins seen over the inner thigh or calf. They commonly arise directly from the long or short saphenous veins. These are best treated by removal of the vein either by surgery (stripping) or by an endovenous technique (laser or RFA) or may occasionally be treated with a special form of Injection sclerotherapy using foam and guided by ultrasound.
types of TREATMENTS >
No Active Treatment – Reassurance / Compression and Elevation
In over 90% of cases, varicose veins require no specific treatment. The risk of DVT or ulcer developing from uncomplicated veins is extremely low. Wearing support stockings during the day and whilst flying can provide relief from symptoms like aching, heaviness, itching, and swelling. Elevating the legs when sitting and avoiding long periods of standing still or sitting with legs dependent (hanging down) will also help.
Sclerotherapy is very effective for small “reticular” and “spider” veins. It involves injection of a chemical that scleroses ('gums up') the varicose veins. An irritant chemical (Polidocanol is used at VASC) is injected into the veins causing them to collapse. After a period, the walls of the veins naturally seal together so the vein can no longer carry blood and the veins fade away and eventually become almost, or completely, invisible. Compression stockings must be worn after the procedure to keep the veins collapsed while sclerosis takes place. After the operation, there may be bruising and brown staining of the skin which is usually temporary but can last some months after the procedure.
To see some video examples of the positive effects of Sclerotherapy Treatments please visit out GALLERY.
For further reading and more information about Sclerotherapy please click the button below to download our information booklet.
Phlebectomy is local removal of veins through very small cuts (approximately 1-3mm). It is a normal part of open surgery (stripping) but can also be done as a stand-alone procedure under local anaesthetic when it is called “ambulatory” to emphasise the fact it does not require a stay in hospital. It is useful for small areas of vein dilatation but does not usually fix the underlying problem when performed alone and vein re-occurrence is common. Some people may find it quite uncomfortable when performed under local anaesthetic. Before you allow a specialist to undertake ambulatory phlebectomy, check that they have performed an ultrasound to exclude any problems with the main veins of the leg. Veins will rapidly return if not.
Surgery (Commonly called “stripping”)
Although small localised varicose veins can be well managed with injections, open surgery, which is the traditional method of treatment, is still the best choice for many patients. It is the only treatment that completely removes the main vein that is responsible for the varicose vein development as well as targeting the valves responsible for the vein formation of varicose veins. It is often referred to as "high ligation and stripping" since the main valve in the affected vein is tied off (ligated) at the groin (high in the leg) and then most of the vein is then removed in one go (stripped).
Some people suggest that stripping is out of date, traumatic or barbaric. However, these descriptions are emotive, non-factual and usually promoted by practitioners who are unable to offer surgery and are specifically trying to “sell” another technique. Stripping does require longer to recover from than Endovenous treatment (laser) and does requires a scar in the groin area which may be uncomfortable for several days or weeks. Return to work is in one -two weeks depending on occupation which is longer than for other forms of treatment such as endovenous laser.
Surgery is performed under general anaesthetic and usually involves a cut of 2-3cm in either the groin skin crease or behind the knee. The main leaky valve is located and tied off and the operation is completed by removing any prominent remaining veins through number of tiny (1-2mm) cuts. (“avulsions”). The larger cuts have stitches that dissolve, whereas the others are too small to require a stitch and will just have a “steri-strip” plaster applied.
For further reading and more information about Open Varicose Vein Surgery please click the button below to download our information booklet.
EndoVenous Ablation Therapy (EVT) often called "Endovenous Laser Therapy (EVLT)", RadioFrequency Ablation (RFA) or just “laser vein surgery”
EVT is a relatively new, but well proven, “keyhole” alternative to surgical stripping of the long or short saphenous veins. A laser (or radiofrequency) fibre is introduced through a needle under ultrasound control. The laser closes and seals the vein as the fibre is withdrawn. After the main vein has been destroyed, the branches are treated either with sclerotherapy or phlebectomy. Small veins may sometimes be observed initially since they often reduce in size and do not need additional treatment.
EVT can be performed either in hospital under general anaesthetic or as an office based procedure under local anaesthetic. It normally takes about an hour per leg, and most patients return to work immediately or after a few days. Post procedure pain is minimal and cosmetically there are no major scars. However, for anatomical reasons EVT is not possible in all patients. Furthermore, at this time EVT tends to be considerably more expensive than surgical stripping especially if you have medical insurance since much less is covered that with stripping. The extra cost is due the cost of the laser or radiofrequency probe which can only be used once and the fact that medical insurance does not cover many of the extra costs of performing the procedure in a doctors office rather than in a hospital.
For further reading and more information about EndoVenous Vein Treatment please click the button below to download our information booklet.