Varicose Veins

Varicose Vein Assessment & Treatment

Minimally Invasive, non-surgical Treatment of varicose veins

Varicose veins vary in their size and location in the leg. Based on these parameters, different treatments can be offered at Southern Vein & Cosmetic Centre. Dr Andronicus manages varicose vein disease with either Endovenous Laser Ablation (EVLA) or Ultrasound Guided Foam Sclerotherapy (UGFS) or, as is often required, both. These treatments are usually offered in the same primary treatment session.

Endovenous laser ablation works by closing down the varicose vein with laser energy emitted from a laser fibre carefully placed inside the vein. The laser energy creates a reaction within the vein which results in its closure as the laser fibre is slowly withdrawn. Ablation is the treatment of choice internationally for large varicose veins.

Sclerotherapy is the injection of specific chemicals, in either liquid or foamed form, into superficial and surface veins. These chemicals deliberately disrupt the lining of the veins being treated, instigating a response which ultimately results in the replacement of the treated vein with fibrosis, obliterating the vein itself. These injections can be done under direct vision for visible surface veins, or under the guidance of ultrasound for superficial varicose veins not visible to the naked eye.

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Endovenous Laser Ablation (EVLA)

EVLA is a clinic-based treatment ideally suited to large varicose veins that sit well below the skin (and not visible). Ablation treatments such as EVLA provide the best long-term success rates of all the treatments available. (and lowest rates of recurrence).

EVLA can be performed in an outpatient setting (ie not in hospital). Ablation has replaced surgical stripping as the first-line recommended treatment for suitable veins. 

After a small injection of local anaesthetic in the skin where the laser will be inserted, and under sterile (surgically clean) conditions, a laser fibre is fed via a cannula into the vein to be lasered. This is performed under ultrasound-guidance as its placement is extremely specific. Dilute local anaesthetic is then injected around the vein to be lasered. This helps compress the vein onto the laser fibre as well as reduce any heat effect from the laser on surrounding tissue in the leg. Most of all, this anaesthetic makes the laser process itself painless. Laser energy is converted to heat inside the vein. The vein is lasered closed as the laser fibre is slowly withdrawn.

What will the recovery be like after EVLA?

After the procedure, some padding and flexible bandaging will be put on your leg.  A class II compression stocking will be fitted on your leg over it. You can walk out and drive yourself home. The local anaesthetic used does not compromise your motor function (strength and power to move) or your alertness. 

Your compression stocking should remain on your leg 24 hours a day for the first 7 days. You will be provided with a waterproof sleeve to protect the stocking-wearing leg in the shower. You should walk at least 30 minutes daily but not exercise strenuously. You are unlikely to need any pain relief. About 1 in 5 people require not more than a dose of paracetamol on the evening of the procedure. 

You will have written post-treatment instructions to follow and reference material, as well as the doctor’s direct number should you have any pressing queries or concerns. 

After the one-week review, your stocking will be worn for one further week, but can be removed for showering and sleeping. Daily walking of at least 30 minutes will continue this week, and will be recommended you continue for up to 6 weeks after treatment.

  • Complications of EVLA have been reported and your doctor will explain these thoroughly prior to any procedure. Serious complications are very rare.

    You are likely to experience some mild bruising which may last 2-3 weeks. Trapped blood may occur along the course of treated varicose veins. This is old blood trapped inside a closed vein. It is not the same as a clot. Trapped blood is not harmful, but it can be painful. It can easily be released by a needle prick at your follow up visits in a straightforward fashion. Pigmentation, usually light brown in colour, can occaisionally develop in the skin overlying treated veins which represents the breakdown products of iron. This is usually very temporary.

    As mentioned, serious side effects are very rare. Allergic reactions can rarely occur to anaesthetic agents. Infection is also an extremely rare complication. EVLA is performed under sterile (surgically clean) conditions to reduce the chance of any infection. Deep vein thrombosis after EVLA is also very rare. Walking and the wearing of firm compression stockings help reduce the risk of thrombosis after the procedure. Your deep veins will be carefully checked on ultrasound at your one week check up visit. Nerve damage can occur rarely after EVLA procedures. For these reasons, we only treat the veins which are a safe enough distance away from susceptible nerves. Sclerotherapy under ultrasound guidance is a safer way to treat varicose veins which lie close to nerves.

Ultrasound-Guided Foam Sclerotherapy (UGFS) For Varicose Veins

UGFS is a treatment ideally suited to smaller varicose veins that can either sit well below the skin or just under the skin.

UGFS can be performed in a clinic-based setting (ie not in hospital). It does not require any anaesthetic.

Sclerotherapy under ultrasound guidance involves injecting varicose veins with specific agents under the guidance of the ultrasound. This means Dr Andronicus can be very accurate and specific about where the agents are injected and how much. UGFS is ideal to treat small to medium sized varicose veins. This is done as a walk-in, walk-out procedure, so there is no downtime.

UGFS can be done as a stand-alone procedure in suitably-sized varicose veins, or it can be done as an adjunct to EVLA treatments (EVLA is performed on large and straight segments of varicose veins, and UGFS can be done to the remaining parts of the varicose system, too small or too tortuous or close to the skin to cannulate with the laser.) The sclerosing liquid chemical acts on the vein wall to close the vein. The liquid is mixed with carbon dioxide to convert it into a micro-foam formulation. This is done for several reasons. Firstly, the foam is easily seen on an ultrasound (whereas liquid is not) so we can be extremely accurate about the placement of the foam. Secondly, the foam displaces the blood in the vein to very effectively contact the vein wall, allowing the chemical to act specifically and effectively on the vein wall more efficiently than with liquid injections alone. The aim is to close all the varicose veins in one leg in one treatment, whilst remaining within safe foam limits per day. 

What will the recovery be like after UGFS?

After the procedure, some padding and flexible bandaging will be put on your leg.  A class II compression stocking will be also fitted on your leg over it. You can walk out and drive yourself home.

Your compression stocking should remain on your leg 24 hours a day for the first 7 days. We will provide you with a waterproof sleeve to protect the stocking-wearing leg in the shower. You should walk at least 30 minutes daily but not exercise strenuously. You are unlikely to need any pain relief. About 1 in 5 people require not more than a dose of paracetamol on the evening of the procedure. 

You will have written post-treatment instructions to follow and reference material, as well as the doctor’s direct number should you have any pressing queries or concerns. 

After the one-week review, your stocking will be worn for one further week, but can be removed for showering and sleeping. Daily walking at least 30 minutes will continue this week. You will be encouraged to keep up this daily walking for at least 6 weeks after treatment.

  • Complications of UGFS have been reported and your doctor will explain these thoroughly prior to any procedure. Serious complications are extremely rare. Common minor side effects are very temporary.

    You are likely to experience some bruising which may last two-three weeks. Trapped blood may occur inside the treated vein. This is not the same as a clot. Trapped blood is harmless, but can be uncomfortable and can be treated by your doctor at follow up visits. Light brown pigmentation is sometimes seen along the line of a treated vein as a result of the deposition of haemoglobin breakdown products being temporarily deposited in the skin for a few weeks to months after treatment.

    As mentioned, serious side effects are extremely rare. Allergic reactions are rare, but known to occur with both the utilised sclerosing agents. Our clinic is fully equipped to manage allergic reactions including severe allergic reactions known as anaphylaxis. Deep vein thrombosis after UGFS is also very rare. Walking and the wearing of compression stockings help reduce the risk of thrombosis after the procedure. Your deep veins will be carefully checked by ultrasound at your 1 week check up visit. Ulceration of the skin after sclerotherapy has been reported, involving patches of skin tissue effectively breaking down as a result of injections. These complications are avoided with the use of high quality ultrasound and astute technique.

    Migraine can occur following UGFS, more commonly in patients who were frequent sufferers of migraine beforehand. It is more common to experience the aura rather than the full progression to migraine. Superficial thrombophlebitis can also occur following UGFS, whereby the skin and soft tissue around a treated vein can become red and tender. This can usually be simply managed and brought under control with simple measures.

FAQS About Varicose Vein TREAMENTS

  • The term “varicose” veins can mean different things to different people. However medically speaking it refers to superficial veins, usually in our legs, which demonstrate “reflux”, or back-flow, instead of flow only in the direction of our heart.

    The used blood from our extremities returns to the heart via veins. Our legs possess three systems of veins; deep veins, superficial veins, and perforating veins (connecting veins between superficial and deep veins). The used blood from our legs returns to the heart by flowing up the leg, when standing, against gravity. The human body can manage this anti-gravity feat by using a number of strategies, including utilising the contraction of our leg muscles to help propel the blood up the veins, and also with the assistance of valves , of which there are many, in the veins themselves. These valves act like gates, which open to allow blood to pass (upwards) then close to prevent the blood moving back down the vein again.

    Varicose veins feature valves which are abnormal. The valves incorrectly reflux venous blood back down the vein instead of only up the vein towards the heart.

  • Influenced by a number of factors, including family history, gender, weight, obstetric history for women and occupation, changes can occur in the walls of the superficial veins which can cause the distention of these veins. This is then also associated with dysfunction of the valves inside these veins. Valves in distended superficial veins simply do not close tightly, so they cannot prevent the reflux of venous blood back down the vein.

    Varicose change can affect your primary, or truncal, superficial veins. It can also affect branch or tributary veins. These veins lie in the compartments of the leg anywhere from above the fascia, or connective tissue sleeve, which houses the muscles of the leg, to just below the skin itself.

  • Varicose veins can be completely asymptomatic (cause no symptoms) or can cause intrusive and troubling symptoms such as ache, heaviness, throbbing in the legs, burning feeling, itchy skin, usually worse after prolonged standing, relieved by elevation of the feet, muscle cramps and restless legs.

    Varicose veins can, for some people, lead to unsightly lumpy veins. Alternatively varicose veins can be otherwise invisible to the naked eye.

  • Regular walking, observing an ideal body weight for height, and even wearing specific compression garments, can certainly delay the onset or deterioration of your varicose veins, and may go some way in easing symptoms from your varicose veins.

    However once varicose change develops in a vein, it will usually steadily and slowly worsen.

  • If left untreated, varicose veins will likely worsen over time. Persisting varicose vein change can lead to venous hypertension, or increased pressure build up inside these veins, which in turn, imparts abnormal pressures into the soft tissue and skin particularly of the lower legs. These changes of venous hypertension can include hyperpigmentation of the skin, inflammatory changes, venous eczema, scarring and ulceration. Some of these are irreversible.

  • The practice of sclerotherapy and ablation is a highly skilled and precise one, and are techniques Dr Melanie has undertaken the highest training available in Australia to practise.

    Dr Melanie utilises high quality ultrasonography which is imperative for accurate pre-treatment assessment, appropriate treatment planning. It is also essential in the safe implementation of Ultrasound-guided sclerotherapy and endovenous ablation of varicose veins.

  • Every sclerotherapy and ablation procedure will be explained in detail, including pre- and post-treatment management, and you will have a clear understanding of the procedure recommended, including how it will be done, how it will work, and possible side effects and adverse events, or complications.

  • Sclerotherapy is not for everybody, and there are a few circumstances in which sclerotherapy is simply contra-indicated. This will be carefully evaluated by Dr Melanie.

  • Optimum outcomes in non-surgical treatments we offer for varicose vein management starts with careful and thorough assessment, to permit the most suitable treatment selection. It then relies on the procedures being done safely and thoroughly, which takes study and specialised training. Outcomes also rely on how you look after yourself in the post-treatment period. Dr Andronicus will explain all of the necessary steps you will need to take in this period to optimise safety and good outcome. These steps will include the requirement to walk daily and wear a medical grade compression garment for 1-2 weeks as a minimum following the treatment.

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