Types ofvaricose vein procedures

Varicose vein procedures aren’t usually urgent, unless you have complications like blood clots or bleeding.

Some procedures can be done in your doctor’s rooms or a day clinic, using local anaesthetic and sedation. If you have high ligation and vein stripping you’ll need to go to hospital and have a general or regional anaesthetic.

All these procedures can cause painful swelling caused by superficial blood clots (thrombophlebitis, also known as venous thrombosis).

Minimally invasive procedures

These procedures work by sealing varicose veins off and diverting the blood to deeper veins. Once you’ve healed the vein becomes a cord of collagen which eventually softens and blends into the surrounding tissues.

Minimally invasive procedures are widely used because of the relatively poor results from standard varicose vein treatments.

Sclerotherapy

Your doctor injects a solution or foam into your varicose veins that causes scarring and makes them collapse. After the treatment, your leg will look worse for a while and then it should improve. You might need more than 1 session, but you can go back to work immediately after each one.

After sclerotherapy, you’ll probably have some itching, aching and discomfort in your treated leg. Going for a 5-minute walk to reduce pressure in your leg should help. You may need to wear compression stockings for a several days to weeks and this will improve the final result.

Possible adverse effects include an allergic reaction to the solution, staining or pigmentation along the line of the treated vein, small injection site ulcers, and rarely deep vein thrombosis.

Sclerotherapy can be used as the first-line of treatment for varicose veins, or after vein-stripping surgery.

Thermal ablation

Thermal ablation can be done in 2 ways: using laser or radiofrequency fibres. Your doctor makes a small cut in the skin to help them puncture the large leg vein with a needle. They then insert the fibre into the vein. The fibre is slowly withdrawn and as it goes it releases heat which destroys the whole length of the vein.

Afterwards, your doctor will fit you with compression stockings or bandages to maximise the effect of the procedure. You can return to work within 1 or 2 days.

Possible adverse effects include bruising, pain and, very rarely, skin burn. Additional treatments are often needed after thermal ablation.

Mechanical chemical ablation

In this procedure, called ClariVein®, your doctor uses an instrument that bruises the inside of the vein. The mechanical abrasion of the vein, together with a special fluid, collapses the vein wall. It’s done under a local anaesthetic, and you won’t have to take any time off work.

Possible adverse effects include itching, pain and skin discolouration over the treated vein.

Vein gluing

In this new technique, called VenaBlock®, glue is used to collapse and seal the vein. Your doctor first uses local anaesthetic at the puncture area, then inserts glue to seal the vein.

Possible adverse effects include skin discolouration and swelling.

Ambulatory phlebectomy

This is minor surgery in which your varicose veins are removed through small incisions, under a local anaesthetic. It can be done in a day clinic and you can go back to work the next day. You may need to wear compression stockings, depending on the extent of veins removed.

Possible adverse effects include infection, bleeding and scarring. Other complications are quite rare.

High ligation and vein stripping surgery

Your surgeon ties the varicose vein at the point where it meets the deep vein, then removes the whole superficial vein from your leg through two or more small incisions. Blood circulation to your leg isn’t affected, because the deep vein system remains intact.

This surgery is done under regional (the area is numb but you’re still conscious) or general anaesthesia. You’ll need to stay in hospital for a few hours afterwards, possibly up to 2 days, depending on the extent of your surgery.

This procedure carries all the usual risks of surgery. You’ll need a week off work and for the first 2 weeks you’ll need to wear a compression stocking. You can expect bruising afterwards, which improves within a month.

Which is the best procedure for me?

Minimally invasive treatment options are becoming increasingly popular. One 2016 review reported a 98% success rate after one treatment for laser and 97% for radiofrequency ablation.

Another study showed that 50% to 80% of varicose veins may be eliminated with one session of sclerotherapy, although repeat procedures may be needed. Unfortunately, some veins don’t respond at all.

At least 90% of people have long-term success with ambulatory phlebotomy, but it’s not suitable for all types of varicose veins.

Vein stripping surgery has also improved, with smaller incisions and better results.

Recurrence rates after minimally invasive treatment options are about 7% to 10% over 5 years. Recurrence is more common after sclerotherapy. After vein stripping surgery it’s 20% to 50% at 5 years.

If you have ulceration you’ll probably have to wait until the ulcer is healed before you can proceed. The best technique for you would be thermal ablation, ultrasound guided sclerotherapy or a combination of the two.

If you have venous eczema or chronic deep vein insufficiency, all of the available treatments can be used.

It’s important to find a surgeon who’s skilled in the particular type of varicose vein procedure you’d prefer to have. Ask your GP for a recommendation and referral.

Costs

Some varicose vein procedures can be expensive, so check out the costs in advance. You may be able to claim a Medicare rebate for your procedure, provided your doctor believes it’s medically necessary, rather than just cosmetic. You might be able to claim for compression stockings if you have extras cover.

Minimally invasive procedures

Most minimally invasive treatments are done outside of hospital, so can’t be covered by hospital insurance, only Medicare.

High ligation and vein stripping surgery

If your surgery is done in hospital, Medicare and (eligible) hospital insurance should cover some or all of the cost.

Results vs. risks of the procedure

The benefits and potential complications of the procedure.

IMPORTANT INFORMATION

Information is provided by HCF in good faith for the convenience of members. It is not an endorsement or recommendation of any form of treatment nor is it a substitute for medical advice, and you should rely on the advice of your treating doctors in relation to all matters concerning your health. Every effort has been taken to ensure the accuracy of the information, however HCF takes no responsibility for any injury, loss, damage or other consequences of the use of this information.