Case Studies

The vein clinic is at the forefront of vein treatments in WA and has the greatest experience of multiple vessel and combined Venaseal (glue) treatments. These amazing results were achieved with two new techniques we have pioneered. Firstly Venaseal adhesive (medical super glue) and secondly Ultrasound Guided Phlebectomy. This 59yr man presented with large symptomatic varicose veins. He had 20 yrs of discomfort and heaviness in his legs particularly towards end of day, night cramps and itchiness.

In view of his occupation as a cabinet maker and desire to have as little time off work and as fast a recovery as possible, a tailored two stage “walk in- walk out” treatment approach was employed. The first stage utilised the latest virtually painless endovenous technology of Venaseal medical adhesive (as recently featured on TV) for closure of the main malfunctioning veins through a single needle puncture on each leg. Treatment of both legs was completed in under 1.5hrs.

The second stage utilised combined sclerotherapy and ultrasound guided phlebectomy of the branch vessels under local anaesthetic. The use of ultrasound allows us to identify and remove residual vein fragments that may be left behind using traditional surgical techniques. These combined techniques allowed him to have the best of both non-surgical and surgical methods greatly reducing the need for further follow up treatments. Symptomatic and cosmetic improvement was immediate and cosmetic improvement will continue as minor bruising settles. A follow up is scheduled for 3 months time to ensure that these excellent results are maintained.

Pre: large veins prior to treatment

Post: 6 days following completed treatment.

This 50yr old man had noticed increasing enlargement of varicose vein in his anterior calf over the last 5 years. The incompetent great saphenous vein (GSV) was the "feeder" for these varicose veins and was eliminated through a single IV puncture site using our latest technology 1470nm endovenous laser and special "radial" fibre which results in less bruising and discomfort than older style laser and cheaper "bare" fibres commonly in use.
2 weeks following treatment the "branch vessels" have reduced markedly in size without the need for invasive surgery (no GA, cuts, bruises or stitches). Ultrasound guided foam sclerotherapy was administered at 3 months to close the small remaining branches. These results were obtained with two treatments of less than 1hr each on a "walk in - walk out" basis without the need for any surgery.

Pre treatment: Very large varicose veins right calf due to incompetent right great saphenous vein (GSV)

Post treatment: 2 weeks post EVLA (endovenous laser ablation) of right great saphenous vein (GSV) showing a marked reduction in the size of the varicose veins.

Post treatment: 18mth follow up show that all prominent veins have now resolved without the need for any surgery!

43yr old tennis coach, with recurrent varicose veins following two prior operations and sclerotherapy. Prior deep vein thrombosis following surgery. Left swelling after plane travel.

Pre: Recurrent veins following two prior tripping operations as well as prior sclerotherapy.

Post: Non-surgical treatment with EVLA and UGFS (ultrasound guided foam sclerotherapy).

Patient 3 is the younger brother of case 2. Although the visible veins are less pronounced than his brother, his symptoms were more severe and included heaviness, pain, restlessness, night cramps and itchiness in the leg. This case highlights the hereditary nature of varicose veins and the fact that the size of veins does not relate to symptoms. Symptoms may be present despite minimal or even no varicose veins.

Pre treatment: small varicose veins right calf due to incompetent right great saphenous vein (GSV)

Post treatment: 6 monthly review following EVLA (Endovenous laser ablation) of the right great saphenous vein (GSV) and ultrasound-guided foam sclerotherapy (UGS) showed marked cosmetic improvement with complete resolution of symptoms. Annual clinical and sonographic follow-up is however advised as venous insufficiency is a progressive disease and more vessels may become affected over time.

39 yr old woman with 16yr history of pain, heaviness, tiredness, swelling, itchiness in legs. Advice from vascular surgeon following ultrasound elsewhere (said to have been done at specialised vascular lab) was that pelvic embolisation and stripping was required. Our investigations revealed no pelvic incompetence but an incompetent perforator vein and incompetence of the GSV & SSV on both sides. Patient delighted that no surgery or embolisation was required.

Pre treatment: Legs are swollen and multiple varicose veins are evident

Post treatment: Photo several months following laser ablation of all incompetent veins. Leg swelling has markedly reduced, no residual bulging veins are present. Patient delighted that no surgery or embolisation was required.

This 37yr woman experienced severe skin irritation for many months to the point that scratching caused bleeding of the skin. Steroid cream had provided only temporary relief. Ultrasound showed marked incompetence of the main superficial veins and large varicose veins were shown deep to the area of skin irritation despite no varicose veins being visible on the surface. This represents venous eczema due to “hidden” varicose veins, a condition that is frequently overlooked/misdiagnosed. Definitive treatment requires ablation of the refluxing veins that are causing the skin irritation.

Pre treatment: Marked skin irritation and inflammation causing severe itch. Ultrasound showed incompetent great and small saphenous veins as well as interconnecting veins

Post treatment: 2 weeks following combined endovenous laser and foam sclerotherapy treatment Symptoms of itch have resolved Skin is much less acutely inflamed

This 53 yr old woman had many years of unremitting itch and skin irritation involving the medial and lateral calf of her left leg. Experiencing intermittent ulceration and only temporary relief from steroid creams.

Post treatment review at 6 weeks: Tripple Vessel EVLA (Endovenous laser ablation) utilising advanced Endovenous skills including TRLOP technique acquired during training with Professor Mark Whiteley. Ultrasound guided Foam sclerotherapy. Venous ulcers now healed (pigmentation persists) following ablation of great saphenous and 2mm incompetent perforator vein adjacent to ulceration.

Venous ulcers now healed (pigmentation persists) following ablation of great saphenous and 2mm incompetent perforator vein adjacent to ulceration.

Venous eczema has completely healed following ultrasound guided foam sclerotherapy to underlying incompetent vessels.

Varicose veins no longer visible following ablation of anterior accessory saphenous vein which was the “feeder vein” to thigh varicose veins.

49yr woman with painful and unsightly varicose veins for over 20 years.

Pre: Prominent veins anterior and lateral thigh

Post: 5 months following EVLA (endovenous laser ablation) & UGS (ultrasound guided sclerotherapy). All symptoms have gone along with prominent veins.

79yr old male ballroom dancer bothered by symptomatic venous insufficiency. Painful, heavy and tired legs limited his participation in his favourite pastime (ballroom dancing). In view of his age he did not want to undergo surgery and was keen to have as little time off his feet as possible.

Pre treatment: Ultrasound revealed bilateral GSV incompetence as well as perforator and SSV incompetence.

Post treatment: Non invasive EVLA (endovenous laser) and UGS (ultrasound guided sclerotherapy) treatments were undertaken under local anaesthetic allowing for walk in walk out treatment and quick recovery.

Post treatment: Rapid symptomatic and cosmetic improvement following treatment allowing early return to dancing. Follow up ultrasound showed all vessels closed with no need for further treatment.

Post treatment: Follow up ultrasound showed all vessels closed with no need for further treatment. Annual review is still however advised to allow for early detection and treatment of any recurrence.

24 yr old female with symptomatic varicose veins and venous reflux (right > left leg). Painful varicose veins especially after long periods of standing, strong family of varicose veins. Ultrasound study showed bilateral reflux in the great saphenous veins.

Visible varicose veins medial and posterior calf

Patient so pleased she has now booked for EVLA of left leg.

54yr male with 20 yr history of pain, itchiness, tiredness and swelling of the leg. Ultrasound revealed incompetent great saphenous vein (GSV).

Visible varicose veins left calf

2 weeks following endovenous laser surgery (EVLA) to great saphenous vein symptoms have resolved and varicose veins are markedly reduced in size.

59yr woman with 11yr history of heaviness, tightness, itchiness, tiredness and night cramps affecting the right leg.

Visible varicose veins posterior knee (popliteal fossa). Ultrasound revealed incompetent small saphenous vein (SSV) and several incompetent perforator veins.

Photo taken 5mths post laser surgery to incompetent SSV & perforator veins with additional ultrasound guided foam sclerotherapy performed at 1 and 3mths following laser. No residual visible varicose veins but ultrasound showed some residual incompetent vessels that were treated with “touch-up” foam sclerotherapy to prevent future recurrence.

25 yr man with history of recurrent right lower limb varicose veins 4 years post foam sclerotherapy (treated elsewhere) complicated by deep venous thrombosis.

6mths post EVLA (endovenous laser ablation) of right great saphenous vein. Complete resolution of varicose veins. Without need for sclerotherapy

29 yr man with history of varicose veins since age of 12 years. Symptoms of pain heaviness and swelling.

10 weeks post EVLA of right great saphenous vein with complimentary foam sclerotherapy to tributary vessels.

Symptoms now completely resolved along with visible varicose veins.

59yr old woman with symptomatic venous reflux (great saphenous vein) and cosmetic spider veins. Symptomatic improvement and great cosmetic result following our three stage treatment protocol.

1. Treatment underlying major refluxing veins with endovenous laser
2. Treatment of branch veins and “feeder” veins with ultrasound guided sclerotherapy
3. Treatment of surface veins with microsclerotherapy