Procedures > Surgery > Varicose Veins

Varicose Veins

The Skin Institute offers all the treatments available for all forms of venous disease. The spectrum spans from cosmetic forms of vein disease such as spider veins through to varicose veins and debilitating problems such as venous ulcers.

Varicose veins

Varicose Veins are usually caused by an incompetent valve system allowing blood to return into the superficial layers just beneath the skin. The increasing pressure in the thin walled skin veins can then lead to an increase in size of these veins and further failure of valves.
The result is usually a rapid progression of visible and palpable varicose veins once established.

Retrograde flow of blood leads to mixing of oxygen deprived blood with oxygen rich blood resulting in low levels of O2 and reduced nutrients in the skin. This leads to discomfort and pain, usually worse as the day progresses and into the evening. Further symptoms include itchiness associated with dry skin, a burning sensation, restless legs at night, swelling of the ankles and skin quality changes. In severe cases (sometimes in patients as young as 20) one might see brown-black skin discolouration, varicose eczema around the ankles and even ulceration.

Treatment

The traditional options of surgical “stripping”, tying or avulsion have been refined over recent years but still require a general anaesthetic. Skin Institute vascular surgeons can perform this procedure for you in one of our purpose built day-stay facilities. Recovery time is between 1 and 2 weeks with only minimal bedrest in the first 12-24 hours. No follow up treatments are usually required.

Another option has been refined over the last 10 years - Endovenous Laser Ablation or EVLA. This treatment involves the passage of a laser fibre into the affected vein under local anaesthetic and subsequent internal cautery and closure of the vessel. The remains of the treated vein immediately scar shut and will be absorbed by the body within 3-6 months.

Usually this treatment needs to be augmented by Ultrasound Guided Sclerotherapy to the lower legs and/or smaller tributary veins in the thighs. Recovery time is rapid with the ability to return to work on the following day with only minimal discomfort. Compression stockings need to be worn for 3 weeks. 
Follow up treatments are usually scheduled for 1 week, 3, 6 and 12 months.

The third option is Ultrasound Guided Sclerotherapy. In isolation this treatment can provide good success rates but is not comparable to surgery or EVLA. However, tortuous veins or small calibre veins that are too small to admit a laser fibre leave only this option. It is particularly effective for recurrent varicose veins. We have achieved good results with closure rates close to 90% at one year but recommend the combination between EVLA and UGS as the most reliable non-surgical treatment option.

The choice of which of the three treatments is most suitable for a patient is based on a duplex ultrasound mapping of the veins. Patients with varicose veins should always have an ultrasound map before any intervention or treatment. We provide ultrasound mapping at our Takapuna, Silverdale, Queenstown and Dunedin clinics. Insurance companies usually cover the cost of this.

Possible Side Effects

  • Palpable lumps which will resolve in time
  • Discomfort or pain
  • Bruising
  • Allergic reaction
  • Infection (rare)
  • Deep vein thrombosis (rare)

     

Aftercare instructions

  • Compression stockings need to be worn day and night for the first week.
  • Compression stockings need to be worn during the day for another 1-2 weeks.
  • Walk for 30-60 minutes every day for the next 2 weeks.
  • Strenuous exercise should be avoided for 2-3 weeks following treatment.
  • If you have areas of bruising or pigmentation, you should avoid sun or sun bed exposure.
  • No air travel for 2-4 weeks.

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Click here for info on Spider Veins.