New Treatment Options for Varicose Veins

Minimally Invasive Techniques to Remove Varicose Veins

Dr. Shannon D. Thomas FRACS

Vascular, Endovascular and Renal Transplant Surgeon

Visiting Medical Officer

Southern Highlands Private Hospital

Varicose Veins affect 30% of the human population!!!

About 5% will develop venous ulceration

Many reasons for treatment

Common Reasons for Treatment

PainDiscomfort/swelling

ThrombosisBleeding

Venous ulcerationAppearance

Tailor solution to indication

Treatment Options

1.Lifestyle adjustments

1.Medical therapy

1.Compression Stockings

1.Sclerotherapy / MicroSclerotherapy

1.Open Venous Surgery

1.Endovenous Ablation

Lifestyle Adjustments

Avoid prolonged standing

Weight loss

Increase walking and exercise

Workplace seating/ environment

Medical Therapy

May improve symptoms of varicose veins and may also improve appearance of varicose veins

Horse Chestnut Seed ExtractBioflavonoidsGinko Extracts SaponinsParoven Forte VenotrexAnthogenol Veins Clear

Available from most health food stores

Compression Therapy

Sclerotherapy

Sclerotherapy

Open Varicose Vein Surgery

Open Varicose Vein Surgery

Endovenous Ablation

Endovenous Ablation

RCTs demonstrate less pain, faster recovery and less recurrence than

open surgery. On cost analysis, perioperative costs are higher, but total societal costs are lower

My Approach

1.Clinical History and examination

1.Duplex Venous Ultrasound: Venous incompetence

1.Duplex Arterial Ultrasound: If no pulses or risk factors

Lifestyle and Medical treatments appropriate for most patients

Venous Insufficiency with Incompetent Great and

Short Saphenous Vein (with or without ulceration)

1.Radiofrequency Ablation and avulsion of varicosities

2.Compression bandage 24 hours, stocking for 6 weeks

1.Back to work next day

Venous Insufficiency with a Large Saphenous Vein (>1cm diameter)

1.Open Saphenous stripping and avulsion of varicosities

1.Compression bandage 24hours, stocking for 6 weeks

1.Expect 1 week off work

Varicose Veins without Saphenous Incompetence

1.Foam Sclerotherapy - compression stocking for 2 days.

1.Back to work immediately

Reticular Veins / Telangiectasia

1.Liquid microsclerotherapy: compression stocking for two days

1.Back to work immediately

1.May require multiple treatments

Endovenous Radiofrequency ablation locally

Sclerotherapy – performed at St Judes Specialist Rooms (Bowral)

Questions?

Thank you