Treatment
The treatment of varicose & spider veins depends on the results of clinical examination and the duplex scan. There is a superficial and a deep vein system in the leg and only the superficial vein or Long saphenous vein (LSV) is treated for varicose veins. These veins have “faulty or damaged” valves that are non-functioning and give rise to the symptoms of varicose veins. After treatment of the superficial vein or LSV, the blood from the legs now flows upwards through the deep vein system. There are many treatment options and the best option will be catered for each individual patient, in some cases, a combination of the treatment options may be useful.
EVLT |
This procedure is the latest treatment for varicose veins, it is the minimally invasive alternative to conventional vein surgery. It is safe, fast and effective.
A fine needle puncture is perfomed into the thigh vein (LSV) around the knee area, through this needle puncture, a laser fibre is inserted. This is performed using ultrasound guidance.
The thigh vein is called the long saphenous vein and it is this vein that has the “faulty” valves that cause varicose veins.
The laser fibre is heated and damages the inner lining of the “faulty” vein, this causes the vein to collapse and close, the collapsed vein disappears over time.
This procedure is performed under sedation or regional/general anesthesia and is usually done as a day case. EVLT of a single leg usually takes less than a hour.
All patients are able to walk after the procedure and usually return to normal activity within a few days. There is no lengthy hospital stay, no scarring and minimal pain. Patients are encouraged to walk as much as possible after EVLT.
Possible complications include haematoma, bruising, numbnss and phlebitis which are all not serious.
Maximum benefit can be observed after 4-6 weeks and residual varicosities can be treated either by injection sclerotherapy or ambulatory phlebectomy.
The most recent studies have shown EVLT to have good results up to a maximum of 5 years and a success rate of > 98%.
Most patients will wear elastic stockings for at least two weeks after treatment, depending on the size and extent of the vein treated. This procedure has been done for decades and has been proven to be safe and effective, it has a success rate of > 95%. It involves a small incision in the groin and removal of the “damaged” vein (LSV) via the groin incision. Other small incisions are made below the knee to remove varicose veins.
This procedure requires general or regional anesthesia. It requires hospitalization, longer recovery period and has more post operative pain/scarring when compared to EVLT.
This procedure has also been proven to have more bleeding, wound infection rates as compared to EVLT.
Conventional vein surgery is still recommended for some patients who some reason or other may not be suitable for EVLT.
Injection Sclerotherapy |
This procedure involves using a fine needle to inject a sclerosant( liquid) into these small veins. The sclerosant damages the lining of the veins and causes it to collapse. The veins and then reabsorbed by the body.
The procedure requires multiple sessions, approximately 6 to 8 weeks apart and possible side effects can be bruising, hyperpigmentation and inflammation. This procedure is performed in the clinic with topical anesthetic cream, takes about 30-45 minutes and there is no downtime. Normal activity can be resumed immediately. About 10-20% of these spider veins may never disappear even after treatment. If the spider veins reappear, it is usually a result of underlying venous reflux and as a courtesy to our patients, we would recommend a thorough assessment of the entire venous system.
Injection sclerotherapy can also be performed after EVLT treatment for varicose veins to improve the aesthetic appearance of the leg, it is safe and effective. Injection
sclerotherapy is best for spider veins, reticular veins and some small varicose veins. |
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Using a fine needle, sclerofoam is injected carefully into these spider veins and reticular veins. Sclerofoam is mixture of sclerosant (liquid) and air. The sclerofoam damages these small veins and causes them to collapse, these veins are then reabsorbed by the body.
This procedure is performed in the clinic, it requires multiple sessions, approximately 6-8 weeks apart. UGFT is performed with topical anesthetic cream, there is no downtime and patients can resume normal activity immediately. Possible complications include bruising, bleeding or staining but all of these are not serious.
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UGFT |
Laser Treatment |
This is the latest modality for the treatment of spider veins. It is fast, safe, easy and effective. The laser beam heats up the blood in these veins and causes the veins to collapse.
The procedure is performed in the clinic with topical anesthetic cream and takes approximately 30-45 minutes. There is minimal or no pain and no downtime, the patient can resume normal activity immediately. This treatment should be performed 6-8 weeks apart and for best results, avoidance of direct sunlight to the treated area is recommended.
Some possible side effects are inflammation, bruising and hyperpigmentation. This is the best treatment for fine spider veins and reticular veins
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This procedure involves making small incisions along the varicose veins and removing them using special tools. It may require multiple incisions and local anesthesia is needed.
It can be performed in the clinic with minimal downtime/pain and the patient can resume daily activity within 24 hrs.
It can be performed as an adjunct to EVLT and possible side effects include, bleeding and haematoma and numbness. These stockings have to be properly measured for each patient; they help by improving the upward flow of blood in the leg veins.
They should be worn during the day and removed at night, these stockings come in various lengths, colors, compression and sizes to cater to each individual patient and their needs.
Stockings can be used in the interim before surgery or after vein surgery to improve recovery. Dr Sanjay believes that patients that understand their condition make informed decisions and reap the most satisfactory outcome. With his unique patient- centred approach, Dr Sanjay explains to all of his patients the nature and treatment options of their vein condition. As a patient, you will be included in the decision making treatment process.
Before any treatment is suggested, all patients receive educational material, have a full history taken by Dr Sanjay and undergo a complete clinical examination which may include a duplex ultrasound to evaluate the venous circulation. After the examination and consultation, you will understand the nature of your vein condition and then treatment options can be discussed to cater to your individual needs.
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If you would like any further information or wish to schedule a consultation, please call (65) 6475 1002.
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