Varicose Vein Treatment
Blood flows from your heart to the rest of your body through arteries. It is then carried back to the heart through your veins. Blood is meant to flow in one direction, so veins have small valves that help prevent it from flowing backwards. When the vein walls stretch or the valves stop working properly, blood can pool and cause the veins to enlarge.
These enlarged veins, when they are near the surface of the skin, can become visibly twisted and bulging. These are varicose veins.
Varicose veins are often associated with faulty valves in the main superficial veins of the leg, called the saphenous veins. The great saphenous vein runs along the inside of the leg, while the small saphenous vein runs along the back of the calf.
Varicose veins are one type of abnormal vein. Other types include spider veins—the fine red or purple veins near the skin’s surface—and reticular veins, which are blue and lie slightly deeper beneath the skin.
When the valves no longer work properly, this is described as venous “incompetence” or “reflux”.
Symptoms
As well as visible bulging veins, symptoms may include:
- Aching, heaviness or tiredness in the legs.
- Swelling around the ankles or lower legs.
- Itching, burning or cramping.
- Tenderness or discomfort around the affected veins.
Symptoms may be more noticeable after prolonged standing or towards the end of the day. In more advanced cases, skin discolouration, eczema or ulcers may develop around the lower leg and ankle.
Different stages of venous disease, from left to right; varicose veins, swelling and skin changes, swelling, skin changes and ulceration. © 2017 Medtronic Inc. used with permission
Causes
Varicose veins often run in families. They may develop or become more noticeable during pregnancy and become more common with age.
Other factors associated with varicose veins include being overweight, spending long periods standing and a previous blood clot in the leg.
Diagnosis
Although varicose veins are often visible, an ultrasound examination helps identify which veins and valves are affected.
A duplex ultrasound assesses the direction of blood flow, identifies areas of reflux and checks the deeper veins. This allows treatment to be planned around the underlying cause as well as the veins visible beneath the skin.
When should varicose veins be treated?
Varicose veins that are not causing symptoms or skin changes do not always need treatment. Some people choose treatment because they are concerned about their appearance.
Assessment is particularly helpful when veins cause persistent aching, swelling or discomfort, or when there are skin changes, bleeding or ulcers.
Dr Daniel Hagley is a varicose veins doctor in Brisbane who assesses and treats varicose veins. He will discuss your symptoms, ultrasound findings and treatment goals before recommending an approach.
How are varicose veins treated?
Treatment often involves addressing both the underlying vein with faulty valves and the visible varicose veins beneath the skin.
VenaSeal: closing the vein with medical adhesive
Dr Hagley predominantly uses VenaSeal to treat reflux in the great or small saphenous veins.
During treatment, a thin catheter is passed into the affected vein under ultrasound guidance. A small amount of medical adhesive is delivered to seal the vein closed. Blood then returns through other functioning veins.
VenaSeal closes the vein without using heat and avoids the need to strip out the saphenous vein.
It is not suitable for everyone. Your medical history, including any previous reactions to medical adhesives, will be considered when choosing treatment.
Radiofrequency ablation: an alternative using heat
Radiofrequency ablation, or RFA, uses controlled heat delivered through a thin catheter to close the affected vein.
Dr Hagley offers RFA when patients prefer this approach or when concerns about a possible adhesive allergy make it a more appropriate option.
Both VenaSeal and RFA treat the underlying refluxing vein. Additional treatment is often needed for the visible branches.
Phlebectomy for larger surface veins
Phlebectomy removes larger superficial varicose veins through small skin incisions.
Dr Hagley commonly uses this alongside treatment of the underlying saphenous vein to address the larger bulging veins.
Sclerotherapy for smaller veins
Sclerotherapy involves injecting a solution into a vein, causing it to close and gradually fade. Ultrasound guidance may be used when the vein is beneath the skin.
Dr Hagley commonly uses sclerotherapy for smaller varicose veins. Some patients need more than one treatment session.
Open surgery for selected revision cases
Dr Hagley mainly reserves open surgery for selected revision cases, such as recurrent varicose veins after previous treatment.
The most appropriate approach depends on the pattern of veins, previous procedures and ultrasound findings.
Choosing your treatment
There is no single best treatment for everyone. Your plan may combine VenaSeal or RFA with phlebectomy or sclerotherapy.
Dr Hagley will explain the expected benefits, risks and alternatives. Depending on the procedure, risks may include bruising, discomfort, inflammation, skin staining, altered sensation, infection, blood clots or an allergic reaction to the adhesive.
What is recovery like after varicose vein treatment?
Recovery depends on the treatment performed and how extensive it is. You will receive written postoperative instructions tailored to your procedure.
Walking and exercise
Begin walking as soon as you are safely able. Take several short walks and gradually return to normal daily activities as comfort allows.
Avoid prolonged inactivity. Heavy lifting and strenuous exercise should be avoided for two weeks unless you are advised otherwise.
Returning to work
Many people return to work within two to seven days. Physically demanding work, more extensive treatment or ongoing discomfort may require longer.
Compression stockings
Dr Hagley’s usual postoperative plan is:
- First 48 hours: keep the compression bandaging on day and night.
- Next 24 hours: remove the bandaging, put on the supplied stocking and wear it day and night.
- After this: wear the stocking during the day until your clinic review, when you will be advised when to stop.
Follow any individual instructions given by your treating team.
Bruising and discomfort
Bruising, local swelling and tender or firm areas along treated veins are common. Discomfort may become more noticeable during the first week before improving.
Bruising often takes three to four weeks to settle. The appearance of the treated areas continues to change as healing progresses.
Follow-up
Our staff will arrange an ultrasound approximately one week after treatment. Your surgical review is usually two to six weeks afterwards.
Your written recovery guide also explains dressing care, driving, travel and symptoms that need urgent medical attention.
Frequently asked questions
Can varicose veins be treated without surgery?
Yes. Compression stockings can be an effective treatment for managing symptoms of venous disease. When worn properly, compression can reduce venous pressure and swelling and improve symptoms.
For patients seeking a procedure, the underlying vein can often be treated with VenaSeal or RFA without traditional vein-stripping surgery. Larger visible branches may still need phlebectomy through small incisions, while smaller veins may be suitable for sclerotherapy.
Can varicose veins cause swollen legs?
Yes. Faulty vein valves can allow blood to pool and contribute to ankle or lower-leg swelling. However, swelling has other possible causes, so assessment is important.
Sudden swelling, particularly in one leg with pain, should be assessed promptly rather than assumed to be caused by varicose veins.
Will treating these veins affect my circulation?
The veins selected for treatment have usually been allowing blood to flow backwards and pool. Treatment aims to redirect blood through functioning veins.
Your ultrasound assessment checks the deeper veins and helps determine whether closing or removing the affected superficial veins is appropriate.
Can varicose veins come back?
Treatment addresses the veins identified at the time, but it does not remove the tendency to develop varicose veins. New veins may appear, and previously treated veins can sometimes reopen. Further treatment may be appropriate if symptoms recur.
How much does varicose vein treatment cost in Brisbane?
The cost depends on the treatment recommended and its extent. Contact the practice to discuss an estimate for your proposed treatment and any out-of-pocket costs. If you have private health insurance, check your level of cover with your insurer.
Arrange an assessment
If you are concerned about varicose veins, persistent leg discomfort or swelling, contact Hagley Vascular to arrange an assessment with Dr Daniel Hagley.
An assessment and ultrasound can help identify the cause and guide a treatment plan suited to your needs.