Phlebologists (vein specialists) refer to the main superficial veins of the leg the Great Saphenous Vein (GSV) and Small Saphenous Veins (SSV) as Truncal veins as they drain the main “trunk “of the leg.

Varicose veins are swollen, twisted, blue veins that are close to the surface of the skin. Unsightly and uncomfortable, varicose leg veins can promote discomfort, itchy and discoloured skin. They are the result of venous reflux and if untreated can lead to venous ulceration, bleeding and thrombosis.

The branch vessels draining to the GSV and SSV are often referred to as tributary veins and it is usually these veins that dilate and protrude leading to the visible varicose veins.

Ultrasound provides an essential “road map” for the treating doctor to understand the exact nature of your vein dysfunction and plan the most appropriate treatment. Often what is seen on the surface is figuratively speaking the “tip of the iceberg”.

We have seen many patients have unsatisfactory outcomes when treated elsewhere without an ultrasound. Surface sclerotherapy performed without first eliminating venous reflux and “feeder vessels” for example may lead to new vessel growth and a dramatic worsening in cosmetic appearances.

Phlebectomy performed without elimination of underlying reflux (only detectable on ultrasound) similarly will often lead to new vessel proliferation and rapid recurrence of varicose veins.

Whilst a number of clinics offer vascular ultrasound, few have staff skilled in the performance of the highly specialised venous incompetence studies required to adequately understand the nature of your vein dysfunction and the most appropriate treatment.

It is best to have ultrasound performed at a specialised centre that is accustomed to the assessing patients before, during and after endovenous vein treatments. If we are to treat your veins, we cannot rely on assessments done elsewhere and will require our own detailed ultrasound scan prior your treatment.

In addition to modern high frequency ultrasound, the Vein Clinic is one of the few clinics in Australia to use specialised equipment (venapulse ™) to improve the accuracy of our venous incompetency studies.

In the last 15yrs a major revolution in the understanding of venous disease has occurred. Much of this new understanding has been driven by the greater use of high frequency ultrasound by properly trained ultrasound practitioners.

The introduction of endovenous laser ablation (EVLA) for treating truncal incompetence has been a major paradigm shift and has shifted thinking and research towards safer and better tolerated ways of treatment. The dark old days of surgical vein stripping are thankfully coming to an end.

UGS tends to be less than half the cost of ELVA and for that reason has gained popularity as a “catch all” treatment.

At the vein clinic we believe the optimal treatment that gives you the greatest chance of success with the least discomfort is always preferable.

We do not agree with a “one size fits all” approach to UGS and believe that in many instances UGS is not “best practice” for the treatment of primary truncal incompetence. The appropriate choice will be highly dependent on the exact anatomy and size of the veins involved. If we believe UGS is suitable for treating your ,veins, we will offer this option to you. It is only by undertaking a through clinical evaluation and ultrasound scan that we can appropriately advise you of the treatment options best for your individual circumstances.

Studies have shown that the success of UGS declines rapidly with increasing vein size. Once veins are > 6mm in size, recanalization (re-opening) rates increase dramatically and the chance of long term success decreases. The chances of post treatment complications such as thrombophlebitis and pigmentation also increases dramatically.

If appropriate laser energy is delivered to the wall of the vein with EVLA the chance of success is essentially 100%. This chance of success is virtually independent of vein size. The complications following EVLA are also usually minimal if properly performed.

In very tortuous veins that may not be accessible to a laser fibre, UGS can be considered however surgery may be a better option in such cases if the vein is very large or very superficial.

Genetics:

Genetic Risk of varicose veins if :

• Neither parent has varicose veins – 20%
• One parent has varicose veins – 64%
• Both parents have varicose veins – 90%

(Cornu-Thenard, A., et al. Importance of the familial factor in varicose disease, J Dermatol Surg Oncol. 1994. 20:318)

Gender

Although some studies have estimated that 20% of men and 40% of women will develop venous disease in their lifetime, this data has been refuted and it may simply be that men do not report the signs or symptoms of venous disease to their doctors until it is severe, as advanced chronic venous disease is more common in men.

Age

The incidence of varicose veins increases with age. The risk of varicose veins, spider veins chronic venous insufficiency and ulcers all increase with age. A 70yr old is estimated to have twice the risk of varicose veins compared to a 40 yr old.

(Adhikari A, Criqui MH, Wooll V, Denenberg JO, Fronek A, Langer RD, et al. The epidemiology of chronic venous diseases, Phlebology 2000. 15: 2-18.)

Other Reported Risk Factors

There are other risk factors for varicose veins, but these are not as well-supported by the scientific evidence. (Bergan, JJ, Risk Factors, Manifestations, and Clinical Examination of the Patient with Primary Venous Insufficiency, The Vein Book, 120.)

• Obesity – Many studies claim an increased risk of varicose veins in the obese. However when corrected for age, the evidence is weak. It is of course desirable to maintain a healthy weight, and doing so may slow progression of venous disease but once present, weight loss is unlikely to reverse venous dysfunction.
• Standing occupations – Some have shown that those in standing occupations such as hairdressers have an increased incidence of varicose veins.
• Diet –Venous disease is more prevalent in Western cultures than in cultures which have predominantly fibre-based diets, but many other factors come into play beside diet.

Traditional vein surgery for varicose veins which consists of “stripping”, may well result in less out of pocket expense than laser vein surgery which is often referred to as endovenous laser ablation (EVLA). This is because health fund rebates currently only apply to traditional surgery and not laser vein surgery.

Cost savings by having traditional vein surgery however may well be short sighted when one considers the time and income lost by several weeks off work , the inconvenience and added health risk of hospital admission, general anaesthetic and prolonged recovery.

When you weigh this all up, for most people the sensible decision is to spend a little on your health and have the best available treatment rather than an out-dated and inferior treatment. Whilst some initial savings may occur with surgery, in the long run this approach usually end up being more expensive not to mention uncomfortable and inconvenient.

If your flight is longer than 4hrs, it is generally recommended you complete your treatment at least 4 weeks prior to travel. In certain circumstances such as unexpected work travel , we can prescribe a blood thinning agent (Clexane) to be taken prior to travel to reduce your risk of venous thrombosis.

If your concerns are purely cosmetic and relate to spider veins you can see Dr Hoffman who specialised in spider vein treatments without a referral.

If you have varicose veins or symptoms, we recommend you see Dr. Matar, and as a specialist a referral from another doctor is required to comply with Medicare regulations.

In order to maximise the Medicare benefits available to you for the comprehensive ultrasound assessment and subsequent treatment and follow up scans, we recommend you have your GP fill in our dedicated venous services referral forms.

If you have trouble getting into see your own GP or do not have a GP, there are several GP clinic within a few hundred metres of our clinic that can assist in this regard.

The costs will depend on the methods required to treat/remove your abnormal veins, the number of abnormal veins to be treated, the number of treatments required, the time and complexity of each treatment; the amount of consumables needed and will naturally vary significantly from person to person.

Once you have had a thorough ultrasound and clinical examination to identify the extent and nature of your vein problem, we will be in a position to provide a quote for treatment.

Due to the high overheads in running the vein clinic which is a state of the art assessment and treatment centre for venous disease, it is not financially viable for us to “bulk-bill” treatments as the medicare rebates nowhere meet the cost of providing these services.

If you have an appropriate referral from a medical doctor for a consultation and scan, we are happy to provide second opinions. If you have had an ultrasound assessment elsewhere we will generally repeat this at a greatly reduced fee to facilitate you getting a comprehensive assessment in order to allow you to make the best treatment decision for you.