Varicose Veins
Varicose veins occur when superficial veins malfunction, leading to loss of elasticity and dilation. Surrounding tissues fail to support the veins, causing them to become large and tortuous. The valves meant to direct blood to the heart become incompetent, allowing blood to flow backward and pool in the legs. This increases venous pressure and fluid accumulation, which can progress to clotting, bleeding, eczema, skin thickening, and, in rare cases, lower leg ulceration.
Diagnosis
If you have been referred to Dr Bray for the treatment of varicose veins Dr Bray may refer you for a diagnostic ultrasound duplex study prior to your initial consultation.
While you are more than welcome to see Dr Bray without having this investigation first, please note that performing this investigation prior to your initial consultation means that Dr Bray is able to advise the most appropriate treatment for your varicose veins at your initial consultation in most cases.
Determining which modality is most suited for managing your particular pattern of varicose veins depends on accurately assessing your veins to determine the cause and extent of your varicose veins.
This cannot be achieved by simply examining the leg and requires a dedicated specialised vascular ultrasound evaluation by our trained sonographers. This investigation will identify the source of the varicose veins, which can include a failure at the level of the groin, behind the knee or from the pelvis, or direct connections called perforators in some instances. You may also have an investigation to ensure the arterial inflow to the legs is adequate to safely perform treatments that require the use of graduated compression hosiery. Ultimately, the results of the venous duplex evaluation will determine the most appropriate option/s for management.
Scans obtained in non-specialised practices do not convey the information necessary for specialised endovenous treatments such as endovenous laser ablation and ultrasound-guided foam sclerotherapy. Non-specialised scans only provide sufficient information for major open surgery, where the only information required is whether or not one of the main two trunks in the leg is leaking.
Our in-depth specialist vascular studies evaluate the deep veins, the main superficial trunks, and any abnormal communications to the pelvis or deep veins, as well as tracking the varicosities themselves, determining their size, extent and any wall characteristics such as hardening from clots or anatomical variants. All of this information is critical to enable an informed decision as to the best way to proceed with treatment.
Please note that no treatment will be carried out, even on seemingly minor surface varicosities, until a dedicated specialist vascular duplex study has been performed as even minor veins can be associated with significant abnormalities or larger calibre veins that are not visible at the surface. Simply treating the surface veins can be exceedingly costly and will ultimately fail if underlying issues are not addressed primarily.
At the time of your specialised comprehensive venous duplex study you will be provided with information from the Royal Australasian College of Surgeons regarding all of the treatment options for varicose veins. During your clinical consultation Dr Bray will discuss these with you in further detail and advise the most appropriate and effective treatment/s for your specific pattern of venous disease.
Management Options
Varicose veins can be treated conservatively utilising compression garments, or actively, utilising one or a combination of treatment modalities including microsclerotherapy, ultrasound-guided foam sclerotherapy, endovenous laser ablation or surgery.
No treatment modality is perfect and a combination of treatments may be necessary.
Dr Peter Bray established Vascular Solutions in 2007, an evidence based comprehensive vascular and specialist vascular ultrasound practice in Perth, to provide the full range of treatments for Varicose Veins recommended and endorsed by the Royal Australasian College of Surgeons, the Australian and New Zealand Society for Vascular Surgery, the ANZ Society Phlebology and the Australian College of Phlebology.
Vascular Solutions performs regular clinical audits, ensuring that our treatments and outcomes are benchmarked with leading Vascular Surgeons internationally.
Treatment Options
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Varicose vein surgery typically necessitates a general anaesthetic, although a regional anaesthetic may occasionally be used. Patients require an overnight stay in a private hospital, followed by a recovery period that spans approximately two weeks.
For privately insured patients, if you possess private hospital insurance with vascular cover you will generally have no (or limited depending on your fund rebate) out-of-pocket expenses for Dr Bray’s surgical fee.
Varicose vein surgery through the public health system for uninsured patients is only available for individuals with "complicated" cases, such as those experiencing ulceration, venous eczema, or thrombophlebitis. It is essential to be aware that wait times for surgery in the public system can range from six to twelve months, and patients have no capability of selecting their preferred dates for treatment. Furthermore, in the public system, surgery may be conducted by surgical trainees under direct supervision by qualified surgeons.
For those opting to be treated as private patients in a private hospital without private health insurance, it is vital to be aware of the expenses involved. The total cost can be around $5,000, which encompasses charges related to the hospital, operating theatre, anaesthetist, and surgeon. Should you require an estimate of costs, please feel free to request one following your initial consultation.
Read more: https://anzsvs.org.au/patient-information/varicose-vein-surgery/
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Endovenous Laser Ablation (EVLA) is a walk in – walk out same day procedure performed under local anaesthesia. It does not require a general anaesthetic, large incisions or an extended recovery period. Most patients are able to return to work the following day.
The government has deemed this an outpatient procedure, therefore the costs are not covered by private health insurance. There is a Medicare procedural rebate however the significant costs of providing state of the art laser equipment and fibres, and our use of single use sterile equipment and consumables, qualified staff and purpose built procedural rooms to ensure your safety, do come with an out of pocket cost.Read more: https://anzsvs.org.au/patient-information/endovenous-therapy-rfa-evlt/
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Sclerotherapy is a walk in – walk out, outpatient procedure (approximately 1 hour). It does not require a general anaesthetic or an extended recovery period, however multiple treatments may be required.
Sclerotherapy includes microsclerotherapy (also known as direct vision sclerotherapy) for surface veins or ultrasound guided foam sclerotherapy for larger primary varicose veins. In some cases this is the sole modality of treatment. Sclerotherapy is also used as a secondary course of treatment following surgery or EVLA to “tidy up” any smaller residual veins in areas where it is not safe to perform phlebectomies or laser treatment. Sclerotherapy is performed by our Phlebologist Dr Geoff Shulman, an experienced Doctor who works closely with Dr Bray and our sonographers.
The initial consultation fee with the Phlebologist is $145.00. Approximately $80 is rebated by Medicare.
Based on the results of our specialist ultrasound, Dr Bray may be able to determine that your varicose veins are best treated solely with Sclerotherapy. If this is the case you may be offered the option to proceed directly to a consultation with the Phlebologist to save you time and money. You are more than welcome to decline this offer and elect to consult with Dr Bray first.
Out of pocket costs range from $550 – $650 for the first course of treatment. A small Medicare rebate is applicable in some circumstances.
Read more: https://anzsvs.org.au/patient-information/varicose-vein-injections/
Dr Bray prescribes Venosan surgical compression garments.