All you need to know about varicose veins treatment
Having a procedure done can be a daunting process. To alleviate that stress and anticipation, the team at Palm Clinic have created a video to ease your woes. Featuring Dr Sam Dunn, as well as the ultrasound team, it provides great insight into the questions someone suffering from varicose vein issues may have. We have taken all the gems of knowledge from that video and transferred it into this post for easy written reference.
As told by Sam Dunn, vein induction has a number of parts and Sam begins by telling us about the team, the process and why you need treatment.
There are a team of us who do the procedure and over the course of treatment, you may meet a combination of doctors and nurses. We're all very skilled at our jobs and friendly.
After meeting the lovely girls at the front desk and providing your personal details, now we're going to get into the nuts and bolts of how we treat your varicose veins.
In your leg, you have your deep veins. This is the main highway of venous return up the leg. They carry about 90% of blood back up the leg. This is your surface vein, and that is also involved in taking blood back up, but it only does about ten percent of the job.
So the message here is - if this one's not working properly, you can do without it.
The blue one is your calf muscle. Now this works as a pump and squeezes when you walk to push blood up against gravity, up the leg. The valves open up as the blood goes up and when the muscle relaxes, the valves close to stop the blood falling straight back down the leg.
You have valves in your surface veins, but they can become weak over time if you're genetically prone and these are the ones which are prone to failing. So when they're working well, they snap into position and you don't get any backward flow.
When you have varicose veins, this valve has failed and now the blood can go in the wrong direction down the vein. Over time it slowly swells and the drainage in this part of the leg is affected so you can get aching, heaviness, swelling or changes in your skin like Eczema because the skin isn't being drained very well.
So the next step is to do an ultrasound of your leg and have a look at your deep veins, have a look at your surface veins, and map out what's going on.
The gold standard for treatment of varicose veins is laser. And that involves feeding a laser fiber up the inside of the faulty vein, surrounding it with local anesthetic and then firing the laser as we withdraw which seals the vein off with heat.
Usually we can laser the top segment of the vein. The lower part is not usually suitable for laser so this part we will inject with medicine which is designed to make the vein close up and slowly over time, your body will absorb it away.
If the top part of your vein is not suitable for laser, then we will inject the whole length of it. So when we see you at follow-up, there's just a little cord left behind. We’ve taken away the faulty pathway and left behind the deep veins to keep doing their job.
Ultrasound – meet the team
At this point, we'll bring you back to the lovely girls at the front desk who will book you in for your ultrasound.
The Ultra sound team of girls are: Jenny, Kimberley and Tania.
Most people who come to Palm Clinic after their consult will come and see one of the girls in this room. When you come into the room, you'll be sitting on the table and we'll be using the ultrasound machine here which is the same machine that we use for obstetrics scans for babies.
You'll be asked to take off your trousers or your skirt, but if you're feeling a bit shy you can bring shorts along but we normally just place a little towel and most people find it really easy and relaxing to do. We chat a lot and we have quite a nice time.
We put some warm gel on your leg and then we use a probe to see your veins and we'll run it up and down your leg. Usually the scan takes about forty minutes.
An ultrasound map involves looking at both your deep veins and your superficial veins. The deep veins are the very important veins and we just like to make sure they're all normal. The superficial veins are the ones that are responsible for your varicosities. We like to measure these and do a colour-coded map which we then use for treatments so it's used every time you come to Palm Clinic.
At the end of the map, we will give you a treatment plan and you can go to the front desk and make any necessary appointments.
During the scan it is also a good time to ask us any questions that you may have from your consultation with the doctor.
Post treatment instructions
Once you've finished treatment, there are some post-treatment instructions we'd like you to follow.
These are likely to include the following:
- Compression stockings - for the first three days, we'll have you in them 24 hours a day and the remainder of the two weeks, day times only.
- Walking an hour a day for two weeks after treatment. You can split the walk into two half-hour walks.
- No sports or heavy lifting or straining for two weeks.
- No alcohol or smoking just on the days of treatment.
- We don't like you flying long-haul for one week before and one month after treatment.
Car trips - if you're going for a long trip in the car, we like you to get out every two hours and go for a fifteen-minute walk.
We prefer that you avoid Aspirin and anti-inflammatory medication during treatment like Nurofen and Voltarin. Likewise, with iron supplements unless if you have documented anemia, it's best to avoid these as they can increase your risk of brown marks being left on the leg after treatment.
We will put you on a blood-thinning medicine if we think you're at risk of a blood clot. Your doctor will assess you for risk factors and put you on this if they think that you need it.
Before treatment, your varicose veins are kind of soft and spongy. Afterwards, they'll be firm and lumpy contracting down. The lumps will persist for a few months, but the legs can feel inflamed and sore for a month also.
It's normal for you to feel sore and inflamed after treatment so we do advise that you take pain relief. In the first instance, Panadol works pretty well. You take two tablets every four or six hours just like it says on the box. If you're finding that's not quite cutting the mustard, then you can add in some Nurofen or ibuprofen and you take that just like it says on the box; two tablets every six or eight hours.
And in most cases, that will get on top of your pain but if you're finding that’s not working, you can do things like put frozen peas on the sore areas or definitely get in touch with us and we can give you something stronger if needed.
Potential side effects
There are some potential side affects which you need to know about after treatment:
Blood trapping is when the vein is closed off by the injection therapy. Any blood in the vein can get trapped there and it forms a scab. Around a month after treatment, that scab can liquify and it can start to feel tense and tight.
If at any stage you get that tense, tight feeling like a pimple that wants squeezing, do come back and see us because we can put the ultrasound on and if there's liquid inside, then we can drain it out. That will help your lumps resolve faster and reduce your chance of brown marks.
Brown staining is a cosmetic possible side affect of treatment and it's when the blood sits in the vein, the iron in the blood can stain the overlying skin.
The vein actually disappears but leaves a brown mark like a bruise. In the bulk of people who get this, it will fade away, but it can take up to year and a half.
Telangiectatic Matting is a fine growth of spider veins as a result of treatment. The chance of this is around ten percent. If you're in this group, two-thirds of the people who get it, it resolves over time.
Deep Vein Thrombosis, a deep vein clot is about a one in a thousand chance. As long as you wear your stockings and do your walking, this risk remains very low.
Neurasthenia means that you can get little patches of numbness or tingling on bony areas like around the ankle. This will almost always settle with time but can take some months. There have been rare reports of the injection of the medicine into an artery which can block the artery off and cause an ulcer on your skin. This is exceedingly rare.
Thermal injury means that you can get damage to surrounding sutures away from where the laser is done. This has not been an issue for us as we use lots of local anesthetic around the vein to soak up any heat. The treatment can trigger a migraine. It's more common in people who get migraines. Infection is possible but exceedingly rare, we've only seen it in people who are otherwise medically unwell.
There is an extremely rare possibility that the laser fiber can break during treatment. If this happens, we would see it on the ultrasound and we would attempt to remove it here at Palm Clinic. In the unlikely event that we could not remove it, this would necessitate referral to hospital for surgical removal.
Unfortunately, there is no treatment which will last forever for your varicose veins. Laser oblation is considered the gold standard and it will give you the longest lasting result, however, it is possible that you get a recurrence down the track at which time you're most welcome to come back and see us and we can treat you again.
It is normal and expected that you should feel sore and tender after treatment. You will sometimes feel small, firm lumps just under the surface of the skin. Most people find their discomfort is manageable with Panadol and the odd Nurofen. If you're finding this does not cover your pain sufficiently, please let your doctor know so that we can prescribe you something stronger.
So as a reminder, two weeks of walking, one hour per day. Two weeks of wearing your compression hose and two weeks of avoiding sports and straining and heavy exercise.
Restrictions on travel are one week before and one month after a long haul flight. Lastly, please remember to bring your stockings to every follow-up appointment in case we need to do some touch-up treatment.