Varicose  veins   are  abnormal  enlarged  twisted  veins,   typically  affecting  the  superficial  veins  of  the  legs.  Normally,   superficial  veins  have  one-­‐way  valves  that  help  blood  to   flow  back  to  the  heart.  If  these  valves  become  incompetent
(open  and  non-­‐functioning),  blood  pools  in  the  veins   causing  them  to  become  swollen  and  varicose.  Sometimes   varicose  veins  can  also  arise  from  structural  weaknesses  in   the  vein  wall,  or  from  higher  than  normal  blood  pressure  in   the  veins.
Varicose  veins  are  a  common  problem,  affecting  nearly  20-­‐
30%  of  the  population,  with  women  more  often  affected   than  men  by  2-­‐3  times.  The  most  common  type  of  varicose   veins  is  telangectasias.  Due  to  their  appearance,  they  may   also  be  called  spider  veins,  star  bursts,  thread  veins,  or   matted  veins.  Varicose  veins  can  be  more  common  in   people  who  are  on  their  feet  a  lot,  women  following  child   birth  and  those  that  have  a  family  history  of  varicose  veins.
Symptoms
Some  patients  experience  no  symptoms,  but  choose  to  see   their  doctor  because  they  find  the  cosmetic  appearance  of   varicose  veins  unsightly.  Symptomatic  patients  may   experience:
•
No  general  anaesthetics’
•
Fantastic  success  rate
•
Follow  up’s  are  for  life  via  clinic  visits  and   ultrasounds.  All  follow  up's  bulk  billed.
Treatment  is  performed  using  ambulatory  phlebectomy,   endovenous  laser  ablation  and  sclerotherapy.  Some   patients  will  require  only  one  of  these  treatments  others   may  require  a  combination  of  2  -­‐  3  to  ensure  the  best   possible  outcome.
Treatment  Options
Conservative  treatment
Patients,  who  are  having  mild  symptoms  such  as  ache  or   swelling,  are  advised  to  avoid  prolonged  standing  and  to  try   compressive  stockings.
• dull  ache  or  pressure  in  the  legs  after  prolonged   standing  or  walking
• sensation  of  “heaviness”  of  the  legs
• skin  changes  (such  as  itchiness,  pigmentation,   induration)
• recurrent  or  persistent  ulceration
• inflammation  of  the  vein  (phlebitis)
• clots  in  the  vein  (thrombosis)
Ambulatory  Phlebectomy
The  technique  of  phlebectomy  dates  back  to  56  BC,  when
Aulus  Cornelius  Celcus  first  described  it.  Modern   ambulatory  phlebectomy  involves  the  removal  of  varicose   veins  through  small  cuts  in  the  skin.  It  is  a  minor  procedure   performed  using  only  local  anaesthetic  that  allows  the   patient  to  return  to  normal  activities  immediately.
The  procedure  first  involves  marking  out  the  varicose  veins   on  the  patient’s  legs.  Local  anaesthetic  is  given  and  small,   key-­‐hole  incisions  are  made  in  the  skin  along  the  length  of   the  varicose  vein.  The  varicose  vein  is  then  extracted  by   using  a  special  phlebectomy  hook  to  gently  tease  it  out.  The   incisions  made  in  the  skin  are  small  enough  (4-­‐5mm)  that   they  do  not  require  stitches,  and  leave  only  tiny  (if  any)   scars.  Afterwards,  the  patient  is  required  to  wear   compression  stockings  for  up  to  2-­‐6  weeks.
Ambulatory  phlebectomy  is  generally  very  well  tolerated.
Complications  are  rare,  but  may  include  skin  pigmentation,   bruising,  skin  blisters,  dermatitis,  and  infection.  The  long   term  success  rate  is  high  with  >90%  patients  reporting  no   recurrence  of  their  varicose  veins.
Benefits  of  Endovascular  WA's  treatment
• The  treatment  is  minimally  invasive,  which  means   patients  walk  in  walk  out.
•
Very  little,  if  no  scarring
•
No  hospital  visit  or  hospital  fees
Endovenous  Ablation
Endovenous  ablation  procedures  are  able  to  effectively   obliterate  the  internal  vein  space  with  faster  recovery  and   better  cosmetic  results  than  surgery.  There  are  currently  a   number  of  Endovenous  ablation  methods  available:
EVLT  utilises  a  laser  to  close  the  varicose  vein.  A  laser  fibre   is  passed  through  a  small  incision  in  the  ankle  or  knee  into   the  varicose  vein.
©  2010    Endovascular  WA
221  Stirling  Highway,  Claremont  WA  6010
| T  ( 08)  9284  2900                     |F  (08)  9 384  5725                   |  E     reception@endovascularwa.com.au                 |  W   www.endovascularwa.com.au

Once  guided  into  place  by  ultrasound,  the  laser  is  fired,   delivering  laser  energy  to  the  wall  of  the  vein.  This  causes   the  blood  to  boil  and  damages  the  vein  walls,  which  fibrose   and  close  off.  After  the  procedure,  the  patient  will  need  to   wear  compression  bandages  for  a  number  of  days.  This   procedure  usually  only  requires  local  anaesthesia.
EVLT  has  a  high  success  rate,  with  >95%  patients   experiencing  an  improvement  in  their  symptoms.  Patients   are  able  to  return  to  normal  activities  almost  immediately.
One  Australian  study  showed  that  after  3  years,  80%  of   patients  had  veins  that  remained  closed.
Foam  Sclerotherapy
Sclerotherapy  involves  injecting  a  chemical  agent  (a   sclerosant)  to  induce  blood  vessel  scarring  and  closure.
Sclerotherapy  has  a  long  history  and  has  been  used  to  treat   varicose  veins  for  over  150  years.  The  advent  of  duplex   ultrasound  and  foam  sclerosants  has  marked  its  return  as  a   simple  but  effective  treatment  for  varicose  veins.
i.
compression  stockings   ii.
Ensure  you  have  someone  to  take  you  to  and  from   the  clinic  on  the  day  of  your  procedure  (they  can   even  stay  with  you  through  the  whole  procedure)   iii.
Make  sure  you  have  returned  your  signed   information  to  our  Patients'  Service  team  at   reception   iv.
Have  a  shower  on  the  morning  of  your  procedure   v.
Wear  comfortable  loose  clothing
Post  Procedure  Patient  Care
You  will  be  provided  with  post  procedure  instructions  on   the  day  of  your  procedure.  Your  doctor  will  explain  all  care   instructions  to  you  along  with  nursing  staff  and  answer  any   questions  you  may  have.
In  foam  Sclerotherapy,  air  is  mixed  with  the  liquid   sclerosant  to  create  foam.  When  this  is  injected  into  the   varicose  vein  (under  ultrasound  guidance),  it  displaces  the   blood  within  the  vein  and  fills  the  vein.  This  causes  the  vein   to  spasm  and  scar.
The  vein  can  be  checked  with  the  ultrasound  to  see  if  the   injection  has  been  successful.  The  patient  is  usually  asked   to  wear  elastic  compression  stockings  for  1-­‐2  weeks  after   the  procedure.  No  anaesthetic  is  required  for  the   procedure,  and  patients  are  able  to  return  to  normal   activities  straight  away.
Foam  Sclerotherapy  has  a  good  success  rate,  with  80-­‐90%   of  veins  remaining  closed  after  3  years.  To  improve  the   success  rate,  veins  may  need  to  be  re-­‐injected.
Complications  are  infrequent  but  may  include  skin   pigmentation,  skin  sloughing,  vein  inflammation,  transiently   enlarged  lymph  nodes  and  allergic  reaction.  A  number  of   studies  are  currently  being  undertaken  to  determine  the   best  sclerosant  and  technique,  as  well  as  the  long  term   outcomes  of  foam  Sclerotherapy.
Patient  Preparation
Prior  to  a  procedure  for  the  treatment  of  varicose  veins,   patients  are  required  to  complete  the  following
Making  an  appointment
Making  an  appointment  to  see  one  of  or  physicians  is  easy.
We  have  two  options:
1.
Phone  our  Claremont  clinic  on  (08)  9284  2900  and  you   will  speak  directly  to  one  of  our  friendly  Patients’
Service  team  members  who  will  book  your  appoint   and  answer  any  of  your  questions.
2.
Patients  can  book  online  by  going  to  our  website   www.endovascularwa.com.au
.    The  booking  is   tentative  until  you  receive  a  follow  email  or  call  from   our  Patient’s  Service  team  confirming  your   appointment.  Booking  will  be  confirmed  within  one   working  day,  if  not  sooner.
©  2010    Endovascular  WA
221  Stirling  Highway,  Claremont  WA  6010
| T  ( 08)  9284  2900                     |F  (08)  9 384  5725                   |  E     reception@endovascularwa.com.au                 |  W   www.endovascularwa.com.au