Unfortunately, when patients have had Sclerotherapy at another clinic, the results are usually less than impressive. As a consequence the patient thinks that Sclerotherapy doesn’t work for them. The reason for this poor result is usually simple – the reticular veins, the veins that feed into the spider veins, have not been treated PRIOR to treating the spider veins (“telangiectasia”). This is the most common mistake that is made by doctors with the invariable result that either the spider veins do not go, they are made worse or they come back very quickly (less than 1 year). Sometimes the cause for a poor result is that the patient has an underlying deeper problem (that can only be determined by an Ultrasound examination) but this situation is less common. The reason why doctors don’t treat the reticular veins is because they don’t understand the significance of these veins or that they find treatment of these veins too technically difficult. The reason why the underlying incompetence is not diagnosed is because there is often not a high enough “index of suspicion” about the cause of the problem. These issues are addressed by having your veins treated by a doctor who has had accredited training through an established organisation like the Australasian College of Phlebology.

I have often been told by patients that they need surgery to fix their varicose veins. This statement is usually made after the patient has seen either a general practitioner or vascular surgeon. The statement may have been true 20 years ago but has not been correct for the past 20 years since Ultrasound Guided Sclerotherapy (UGS) was first used. UGS is used to treat the underlying incompetent vein that is responsible for the varicose veins that are seen on the surface. More recently, Endovenous Laser Ablation (EVLA) has been used an alternative to UGS to treat the underlying incompetent veins. EVLA is used for the more severe situations and UGS for the less severe cases. These two procedures have now essentially replaced surgery in America and are progressively replacing surgery in the rest of the world.

The reason for these two non–surgical approaches replacing surgery is simple: they have less complications at the time of the procedure and a lower rate of recurrence of varicose veins in subsequent years. Many doctors who have been trained in the traditional surgical technique of vein “stripping” have been slow to adopt these new techniques because of the costs of equipment (ultrasound and laser machines) as well as the time and financial cost of training to be able to perform these new techniques. I believe that to deny patients access to these procedures is bordering on incompetence.

The short answer is a qualified yes.

Varicose Veins: If someone presents with varicose veins I can guarantee that I will get rid of the varicose veins. I can also guarantee that it will be very unlikely that they will ever get any varicose veins related to the underlying vein that I have treated (provided they come in for the scheduled reviews after their initial treatment).

Spider Veins: For cosmetic spider vein concerns I can guarantee that I will significantly improve the current situation.

If a patient has had multiple previous treatments, that have been unsuccessful and have resulted in an even worse situation, then the expected improvement is obviously not as good as if I had the opportunity to treat the legs initially. Of course I cannot guarantee that spider veins or varicose veins will not occur in other areas as this is the result of genetic coding. Treatment of the underlying incompetent veins by Endovenous Laser Ablation or Ultrasound Guided Sclerotherapy does not affect whether veins will occur in other areas.

I have various hurdles that patients must “jump” over before I will treat their spider veins or varicose veins for cosmetic concerns. In a world of increasing concern about physical appearance, I need to be convinced that the cosmetic concerns are reasonable. By this I mean would an average person think it reasonable for the patient to be seeking treatment. I also use the “2 meter rule” whereby if I cannot see any veins standing 2 meters away then I will not treat. Also if a patient has had numerous previous treatments which have resulted in a poor result then I will be reluctant to treat. This situation is like getting lots of poor tradesmen to do a renovation and by the time a skilled tradesman comes along the structure is just too badly damaged to get an acceptable result no matter what the expertise of the tradesman. I also reluctant to treat patients younger than 21 years old because results are generally not as good as for “older” patients and the tolerance of young patients for the discomfort of treatment and side effects is less. Side effects, particularly matting, are more common in younger patients.

I am often asked "Should I get my varicose veins or spider veins treated?" The answer is generally "yes" for someone with cosmetic concerns provided the patient has been fully informed of the risks of treatment and they are realistic in their expectations for treatment. If the cosmetic concerns are minor and the patient is young then I generally advise that they seek treatment when their cosmetic concerns are more significant to justify the cost and risk of treatment. Often a patient will present with large varicose veins that are not really concerning them cosmetically and are not associated with any aching. This situation warrants an assessment of whether the patient has significant risk of complications if the situation is left untreated. This is assessed by making a decision about the relative risk based on the pressure effects into the ankle (and the associated risk of ulceration) and the risk of thrombosis (based on past history and size of varicose veins). For some patients the risk of bleeding is also a consideration.

Obviously the older the patient is then the less likely I am to advise a procedure is appropriate unless there has already been a complication (complications tend to recur). If I am in any doubt whether treatment is in the patients best interests I will suggest a review in 6-12 months to determine the rate of progression.

Spider veins are invariably treated with Sclerotherapy whereby a small amount of solution (the sclerosant) is injected into the abnormal veins to close them off. The body then dissolves these treated veins. Laser treatment of spider veins has produced inferior results to Sclerotherapy. As with all medical treatments the skill of the treating doctor is a critical component to achieving a successful result. The Australasian College of Phlebology has a register of doctors credentialed to perform certain procedures. Varicose veins are increasingly being treated less with surgery (“vein stripping”) and more with the “non-surgical” procedures of Ultrasound Guided Sclerotherapy (UGS) and Endovenous Laser Ablation (ELA). Some Phlebologists still perform adjunctive surgery (ambulatory phlebectomies) in association with one of the non-surgical techniques. Whether UGS or ELA is used depends on many factors with the most important being the size of the vein being treated. The larger the veins are more likely to be treated with ELA.

Compression stockings

These come in a variety of compression strengths ranging from support pantyhose to Class 3 medical compression stockings. In between are the compression stockings that are useful in the prevention of DVT’s when flying and the anti-embolism stockings that are often work in hospital. After Sclerotherapy it is usual for a Class 2 stocking to be worn from 3 days to 2 weeks depending on which vein was treated. As an adjunct to wearing stockings it is important to do as much walking as is possible.

Endovenous techniques (radiofrequency and laser)

In many countries Endovenous Laser Ablation (ELA) is replacing, or has replaced, the traditional surgical “stripping” of veins. The reasons for this are that ELA can be done as an office procedure (walk-in, walk-out) and has less risk than surgery. It also does not have the recovery time associated with surgery. The long term results of ELA are excellent. Importantly the recurrence rate of new varicose veins after surgery, which is often very concerning for patients, is avoided by performing ELA. The technique of ELA consists of placing a small laser fibre up the middle of the vein. This fibre is then very slowly withdrawn from and the laser energy from the tip of the fibre then heat seals as it is withdrawn. The laser is introduced via a 3-4 mm cut (done under local anaesthetic) and the procedure itself is also done under local anaesthetic. Normal walking is possible straight away as the local anaesthetic is not into the muscles but only placed around the vein being treated. The actual laser treatment is painless although some patients report a buzzing sensation.

If you have pain in your legs, fullness, tiredness or heaviness, aching, mild swelling at the ankle, you may have varicose veins. Self care such as avoiding excessive standing, wearing support stocking and raising your legs when resting can help.  However if you are unable to obtain relief from any self care, it is advisable to seek medical attention to obtain a diagnosis.

Diagnosis is simple and is normally carried out by ultrasound. 

There are many types of treatment options for varicose veins including sclerotherapy, ultra sound guided sclerotherpay and laser ablation.Contact us today for an appointment where we can review your treatment options.

There are several reasons as to why some patients get ulcers after sclerotherapy. It appears that using a solution that is too strong or injected with too much pressure is one of the common causes.

Sometimes ulcers are due to the solution being injected outside the vein. With the newer solutions this is not usually a problem but if hypertonic saline is used then injection outside a vein can often lead to deep ulcers.

Sometimes inexperienced doctors (even under ultrasound guidance) have injected solution into arteries instead of veins.

Overall the chance of getting ulcers with sclerotherapy is very low but further underlines the importance of having a very experienced doctor treat your veins.

One of the most challenging aspects of sclerotherapy treatment for veins is the appearance of brown lines along the veins that were treated. These lines (pigmentation) are due to the skin being stained by the iron pigment in blood that is released as the blood within the vein is broken down. It is particularly noticed in people with darker skin and I have seen it particularly with Asian patients and Southern European patients. It is also more likely if very large veins are being treated. Fortunately there are several things that can be done to minimise the chance of pigmentation and these are adequate treatment of the underlying vein, compression of large varicose veins after treatment to minimise the amount of blood trapped and evacuation by needle prick of any trapped blood if it looks to be excessive.

No, but you will develop new veins for the same reason you developed the veins that have been treated. The treated veins are gone for good but new reticular veins and associated telangiectasia (spider veins) will develop over time.

The time for new veins to develop depends mainly on factors such as family history, pregnancy and occupation. It is expected that a forty year old lady would have a “vein free” period of somewhere around 7 years after treatment before she feels the need for a bit of a “tidy up”.

Younger people can expect around 5 years (might be worse if have several pregnancies over this period) and older patients up to 10 years between treatments.