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The decision of which treatment is best for an individual will vary depending on a number of factors including size and position of the veins and whether there are any underlying blood flow or reflux problems.

The optimal choice of treatment for leg veins includes clinical assessment (history and examination) and ultrasound (Doppler and/or colour Duplex), discussion of benefits and possible side effects and consideration of cost effectiveness.

The three main types of vein treatment are:

1. Surgery

2. Surface Treatments

3. Ultrasound Guided Treatment

1. SURGERY

Surgery involves incisions to cut the skin. Surgical procedures are reserved for the treatment of larger veins.

When deeper veins are treated this is called ligation and stripping. This is an invasive procedure which requires hospitalisation, a general anaesthetic and time off work. Whilst this operation is still performed it has fallen in popularity as effective nonsurgical treatments have improved.

For more information see Ligation and Stripping

When superficial varicose veins are treated surgically by small incisions it is called a phlebectomy. This is sometimes combined with ultrasound guided treatments.

For more information see Microphlebectomy

2. SURFACE TREATMENTS

Veins on the surface of the skin can be treated by either a fine needle injection technique (microsclerotherapy) or by laser energy (laser photocoagulation). These techniques are sometimes called direct vision to distinguish them from treatments requiring the use of ultrasound guidance. The term sclerotherapy is derived from “sclero” to seal and “therapy” to treat and refers to the use of fine injections to inject salt based solutions to block off unwanted veins. As the needles used are very, very fine the technique is sometimes also referred to as microsclerotherapy.

For more information see Surface Sclerotherapy

Lasers utilise very specific wavelengths of light to specifically heat up and seal off veins. Surface lasers are most effective on the smallest of leg veins. At the Melbourne Leg Vein Centre we have a range of vascular lasers for the removal of superficial leg veins including Long Pulse YAG, Diode and Pulse Dye Lasers. Combined treatment of laser and sclerotherapy may be indicated for some patients to achieve the optimum results.

For more information see Surface Laser Treatment

3. ULTRASOUND GUIDED TREATMENTS

Advanced colour duplex ultrasound scans allow visualisation of deeper veins below the surface of the skin. The ultrasound is then able to guide the treatment of these deeper veins avoiding major surgical incisions.

There are now a range of ultrasound guided treatment methods available and the choice of the most appropriate technique is determined by a mapping scan which identifies underlying vein reflux problems and the degree and site of any valve problems

For more information see Mapping Scan

The ultrasound can be used to precisely guide the injection of deeper veins with a sclerosant to seal off the faulty veins. This is called Ultrasound Guided Sclerotherapy (UGS).

For more information see UGS

A newer technique involves the use of ultrasound technology to insert a small mechanical rotating wire into deeper veins to improve the ablative effect of the sclerosing solution. This is called CLARIVEIN.

For more information see Clarivein

Instead of using a sclerosing solution an alternative option for treating larger varicose veins is the use of heat (thermal) energy to shut down veins.

When a laser machine is used to generate the heat, which is then applied via a fine fibre inserted into the vein, the procedure is called Endovenous Laser Therapy (EVLT).

For more information see EVLT

When a radiofrequency device is used to generate heat, which is also delivered via a fine fibre inserted into the vein, the procedure is called Radio Frequency Ablation. The company that manufactures the radiofrequency equipment calls this the VNUS procedure.

For more information see Radiofrequency