Frequently Asked Questions – Vein Care Melbourne

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What causes varicose veins and other diseased vein types to become visible?

The causes of varicose veins are still the subject of intense study. One known factor is that varicose veins typically run in families. Varicose veins occur in both men and women, but more frequently in women. The hormone oestrogen may play a role in their development, as puberty and pregnancy can hasten their onset. Additionally, during pregnancy blood flow restriction from the enlarged uterus may be a contributing factor. Spider veins may also occur after trauma or as a result of wearing tight hosiery or girdles.

Varicose veins also appear to be associated with obesity and occupations involving prolonged standing. Spider veins often occur with underlying associated varicose veins that may not be apparent to the sufferer due to their location under the skin. Facial spider veins may be associated with exposure to sun and extremes of temperature; they tend to occur on the nose or cheeks of fair-skinned persons.

Can varicose veins be prevented?

There is no known fool-proof means of preventing varicose and spider veins. For some individuals, wearing specialised venous support stockings may help delay development of some dilated blood vessels. Maintaining a normal weight along with regular exercise – especially walking – may help. Avoid wearing high heeled shoes as these hinder proper function in the larger veins by restricting ankle movement.

What treatments are available to remove dilated blood vessels in the legs?

In the majority of cases, a procedure called sclerotherapy is used to remove varicose veins. A solution, called a sclerosing solution, is injected with a very fine needle directly into the diseased blood vessel. This procedure has been used for spider veins since the 1930’s and long before that for larger veins. The solution irritates the vessel lining, causing it to swell and stick together. Over a period of weeks the vessel fades from view, eventually becoming barely or not at all visible.

Depending on size, a single blood vessel may require multiple treatments, but in any one treatment session several vessels can be injected – this may involve up to 30 injections in one session.

The solutions used vary according to the size of the diseased vessel; your doctor will decide the solution that is best for your particular case. Larger varicose veins often underlie spider veins. In these cases, we believe the varicose veins should be treated before the spider veins, either by sclerotherapy, ultrasound guided sclerotherapy (UGS) or by endovenous laser treatment (EVLT) followed by compression. The type of treatment necessary is determined by a vascular ultrasound examination, which provides a precise diagnosis of any major superficial vein abnormalities.

Why are compression stockings used following treatment?

Following each sclerotherapy treatment session, you will be required to wear a special venous compression stocking that assists in sealing off the dilated veins. The length of time the stocking is required varies: one day to two weeks are typical, determination is by size of the veins injected and the abnormalities detected on the ultrasound scan. It is very important to adhere strictly to the compression instructions advised by your doctor in order to obtain the best result. Compression minimises formation of blood trapping and pigmentation, reduces the number of follow-up treatments necessary, reduces the risk of deep venous thrombosis and reduces the possibility of varicose vein recurrence. Tape dressings instead of support stockings are sometimes used over very fine veins.

How successful is sclerotherapy?

After several treatments, most patients can expect a 70- to 80-percent improvement in treated vessels. The fading process is gradual with treated veins slowly fading up to three months after the last treatment.

How much does treatment for varicose veins cost?

Charges to the patient vary with the condition and the number of treatments necessary. More than one treatment session is typically required. Medicare provides a rebate for injection of symptomatic varicose veins larger than 2.5mm in diameter. Purely cosmetic veins are not covered by Medicare or Private Funds. Prior to commencement of treatment, your doctor will discuss with you approximate costs.

Note: Medicare safety net. Depending on the type of treatment you may be eligible for Medicare safety net. This will be explained to you by the clinic staff on the day of consultation.

Are there any side effects?

Side Effects of Sclerotherapy:

Transient hyperpigmentation (Brown Staining). Approximately 10-percent of patients who undergo sclerotherapy notice discolouration (light brown streaks) after treatment. In almost every patient the veins become darker after the procedure. Once the trapped blood is drained 2-3 weeks after treatment, this temporary discolouration fades away.

  • Telangiectatic Matting. This is the development of tiny new blood vessels in the treatment area. This temporary phenomenon occurs 2-4 weeks after treatment and usually resolves within 4-6 months. It occurs in up to 18-percent of women receiving oestrogen therapy and in approximately 3-percent of all patients.
  • Skin ulceration. Sloughing is uncommon, but it can happen even in the hands of an experienced physician. Skin ulceration is due either to abnormal connection between small veins and arteries or escape of solution into the surrounding skin. Injection ulcers are small and heal very well over weeks, sometimes leaving a small pale scar.
  • Allergic reactions. Very rarely a patient may have an allergic reaction to the sclerosing agent used; this typically presents as a skin rash. At worse (and very rare) an anaphylactic reaction may occur. This is treated by an injection of adrenaline or cortisone.
  • Deep venous thrombosis (DVT). DVT may occur occasionally and may manifest itself with pain in the calf or swelling of the ankle or foot. The approximate risk is 1-in-2000 for sclerotherapy and even less in EVLT. Compression stockings and daily walking are very important following the procedure, as this significantly reduces the risk. Hormone therapy (i.e. the pill or hormone replacement therapy) is usually stopped before the procedure.

Other minor side effects may include:

  • Hair growth at injection sites (localised and temporary).
  • Migraine sufferers may experience headache or visual disturbance following injection sclerotherapy. Simple analgesics like Panadol, Nurofen or other anti-migraine therapies will relieve symptoms.
  • Numbness of the skin is temporary and quite uncommon, due to irritation of the nerves close to the injected vein. At times this may take up to 3 months for recovery.
  • Intra-arterial injection is an extremely rare (1-in-10000) complication resulting in significant skin and muscle damage. This now rarely occurs as ultrasound guided injections and constant monitoring of solution during treatment have increased the safety profile.

By comparison, for surgical removal of veins the side effects are those for any surgery performed under general anaesthesia. These include nausea, vomiting, wound infection and deep vein thromboses.

Will treated varicose veins recur?

Veins treated adequately by sclerotherapy will not recur. However, sclerotherapy does not correct the underlying weakness in your vein walls, therefore new vessels may appear with time. It is important to maintain normal body weight, exercise regularly and avoid wearing high-heeled shoes to minimise the development of dilated veins. An annual check-up is recommended to detect the development of new veins which can then be treated easily.

Are there other treatment methods?

Lasers are occasionally used to vaporise small superficial spider veins and small blue veins called venules. Unfortunately when treating leg veins lasers can cause scars on the skin as well as pigment changes. The pain with laser treatment is greater than injections and the results are not very satisfactory. The gold standard for superficial veins remains injection sclerotherapy.

Lasers ARE effective on barely visible blood vessels under 0.2mm in size. Lasers are especially effective in treating prominent facial blood vessels. Dr. Dhillon uses a Gemini (dual wavelength 532nm and 1064nm) laser for facial veins and occasionally on leg veins in highly selective cases, and in certain others where sclerotherapy is contraindicated due to medical reasons. Ultrasound guided sclerotherapy (UGS) and endovenous laser treatment (EVLT) is for large, bulgy varicose veins.

Ambulatory phlebectomy is done as an office procedure under local anaesthesia. The varicose vein is marked and prepared, tiny incisions are made on the skin and the vein is pulled out with special hooks. Stitches are generally not required, though bandaging is. Scarring is usually minimal.

Surgically tying veins off (ligation) and pulling them out (stripping) are additional procedures that are slowly becoming less popular because of the need for general anaesthetics and hospitalisation, long downtime and high recurrence rate.

What should I do before my varicose vein treatment appointment?

  1. Read this information sheet again.
  2. Do not apply moisturiser to your legs on the day of your appointment.
  3. You may prefer to wear pants to your appointment, as they will conceal the stocking and underlying compression pads.
  4. Always bring your compression stocking for each appointment; its use is vitally important to achieving best results.

What I should do following treatment?

  1. Follow your doctor’s instructions for the best results.
  2. Walk immediately following the treatment for 45 minutes, and additionally every day while undergoing treatment.
  3. Avoid standing for long periods of time.
  4. The time needed for compression stockings depends on the type of treatment you undergo. Your doctor will explain to you accordingly and you will be given written instructions to follow.
  5. Leg waxing can be performed only after a period of two weeks from your last treatment.

To book vein treatment for any of the listed conditions, make an appointment with the Melbourne specialists at Vein Care.

Call us on 1300 568 676 or contact us online