Varicose Veins are diseased veins with incompetent valves and usually therefore reversed flow.

This can lead to:

• dilated unsightly veins
• congestive ache and swelling
• varicose eczema,
• lipodermosclerosis (thickened tissue about the ankle)
• chronic venous ulceration

Spider Veins (Telangiectases) are tiny spidery branching veins.

Reticular Veins are small blue veins that don’t protrude

1. Conservative Management - Usually with an appropriately graded compression stocking plus physiotherapy. This may be required for acute thrombophlebitis (clotted superficial veins) or leg ulcers.
   
   Complications – While compression stockings can be of great benefit particularly for venous ulcers for some people they can be uncomfortable and difficult to take on and off.
2. Micro Sclerotherapy – Very effective for small surface “Spider Veins”
3. Ultrasound Guided Sclerotherapy (UGS) – This is also an out patient procedure which involves injecting usually a foam sclerosant (STD or polidocanol) using ultrasound to guide the needle and assess the success. The sclerosant destroys the varicose veins with good success rates achieved.
   
   Complications – Mild pain, tender lumps (clotted veins) and darkened veins (due to clotting with the veins) are quite common. Rare and more serious potential complications include deep vein thrombosis, allergic reaction, skin pigmentation and skin ulceration.
4. Endovenous Laser Ablation (EVLA) – This procedure has been used for 10 years now. The published results indicate it is at least as effective as surgery, for varicose veins. This technique involves passage of a laser fibre, via a needle puncture, to the main vein under ultrasound guidance plus infiltration of local anaesthetic to compress the vein. The smaller varicose veins are usually also injected at the same time.
   
   

   "Click here" to view a before and after photograph…

   Laser treatment has the advantage of:
   • minimal discomfort
   • no admission to hospital or general anaesthetic
   • only need to take one day off work.
   Complications – Phlebitis or an inflammatory reaction to the occluded thrombosed veins can result in tenderness and discomfort which usually resolves with Panadol or Nurofen. The more serious and much less common complications include deep vein thrombosis, nerve injury (to an adjacent sensory nerve which usually recovers) and skin burns.
   After both EVLA and USG you will need to:
   • wear a compression garment for two-weeks
   • walk as much as possible and maintain normal day time activities but avoid standing still for long periods.
   • Avoid long flights for six weeks.
   • return for an ultrasound check after two weeks.
5. Surgery – Surgery is still the most widely practiced and best-documented treatment.
   
   It has evolved to become a minimally invasive and usually involves a combination of:
   • Ligation of the long or short saphenous vein
   • Striping by the inversion technique of the long saphenous vein to knee level, micro phlebectomies (avulsion of the lower varicose veins though multiple tiny punctures).
   After Surgery:
   • Both legs will be firmly bandaged
   • The following morning these are usually replaced with compression stockings which you
     wear for two weeks.
   • You will need to have someone drive you home.
   • There are no sutures to be removed.
   • It is advisable to take a week off work.
   • Mild exercise is encouraged for the first two weeks.
   Complications – It is to be expected that there will be some bruising and swelling about the thigh after the “stripping” of the long saphenous vein. There is occasionally some numbness due to damage to small sensory nerves that usually recover. Today with modern anaesthesia and surgical techniques, the more serious complications are quite rare. These include deep vein thrombosis, major bleeding, infection, nerve damage and leakage lymphatic fluid from the groin wound.