Why treat Leg Veins?
The commonest reasons for wanting leg veins treated are because people dislike their unsightly appearance; want to reduce unwanted symptoms such as aching and cramps; or because of a combination of both unsightly appearance and unwanted symptoms.
More severe leg veins may warrant treatment because of complications such as excema, bleeding, blood clots or skin ulcers.
Some patients wish to be proactive and treat veins before they become a problem in the future and this is often requested when there is a strong family history of Varicose Veins or Spider Veins and patients have seen what can happen in relatives with untreated Varicose Veins and Spider Veins.
How can I tell if leg aches are due to leg Veins?
Pain and aching in the legs can be the result of a number of reasons apart from veins including blocked arteries, arthritic joints, inflamed muscles, tendon injuries and nerve problems. In some patients there can be multiple causes of aching at the same time, such as groin pain from hip arthritis and reflux from the main vein at the groin.
The characteristics of the leg pain can help distinguish the cause as aching due to leg veins typically deteriorates over the course of the day, is aggravated by prolonged standing and worsens in hot weather. Leg vein pain typically is relieved by elevation of feet, massage and compression with stockings. Leg vein pain may be associated with other symptoms such as swelling of the ankles, leg cramps, tiredness and heaviness.
A common method we use in situations where it is less clear whether pain in the legs is due to leg veins is a ‘trial of stockings’. We get patients to strictly wear compression stockings (20-30 mm Hg) for a period of 2 weeks. If strict wearing of compression stockings does not significantly improve symptoms then it is unlikely treating the leg veins will correct the symptoms. This is important to determine if the only reason a patient wants to treat leg veins is to improve symptoms.
What causes Leg Veins?
Genetic factors play a large role in determining the likelihood of developing Varicose Veins and Spider Veins. The genetic tendency can be inherited from either the maternal or paternal side and there is a much higher chance that a person will develop Varicose Veins or Spider Veins if both parents have Varicose Veins or Spider Veins.
Varicose Veins and Spider Veins can occur at any age but the typical onset is between 18-36 years of age with a peak incidence by 50-60 years of age. Around 50% of adults develop Varicose Veins or Spider Veins at some time in their life and once Varicose Veins or Spider Veins occur they have a strong tendency to continue to worsen as a person ages.
Varicose Veins and Spider Veins are much more common in women than men. Whilst men suffer from unwanted leg veins less frequently than women, if men present with unwanted leg veins, they are much more likely to be Varicose Veins and less likely to be Spider Veins.
Pregnancy is a particular time that Varicose Veins can worsen in women. Multiple pregnancies are an even bigger risk factor for Varicose Veins, and typically with each successive pregnancy the Varicose Veins worsen more during each pregnancy and also recover less after each delivery.
There appears to be an increased risk of developing Varicose Veins in people working in occupations that involve prolonged standing. This includes occupations such as hairdressers, theatre nurses, surgeons and production line workers.
Obesity has an association with Varicose Veins and Spider Veins but it doesn’t appear to be a direct cause and effect relationship as thin people can have Varicose Veins and Spider Veins and overweight people can have none.
It seems if you have a genetic tendency to Varicose Veins and Spider Veins then factors like weight gain, working on hard surfaces and standing stationary for long periods of time will aggravate the condition, but if you don’t have a genetic tendency to Varicose Veins and Spider Veins, then these factors will not necessarily cause Varicose Veins or Spider Veins to develop.
How do I decide on the best treatment option?
The decision as to the best treatment option for Varicose Veins and Spider Veins is an individual one that needs to be made on a case by case basis as it will vary depending on a number of factors including the size of the veins and if there is underlying deep vein problems.
A Leg Vein Consultation is the best first step in determining the type and severity of Varicose Veins and Spider Veins and whether a surface treatment, an Ultrasound Guided treatment or a combination of both approaches is needed.
To determine the best Ultrasound Guided treatment requires a Mapping Scan to identify the position and severity of any underlying deep vein issues. Cost effectiveness is a major consideration as catheter based procedures are much more expensive than injection based procedures and long term results versus cost and downtime need to be fully discussed.
Is Surgery still done on Leg Veins?
Surgery has become increasingly regarded as the treatment of last choice for Varicose Veins. Unlike 10-20 years ago when surgery was commonplace, in current practice surgery is really only considered in the most severe of cases such as Varicose Veins associated with skin ulcers. The reason so little surgical treatment of leg veins is performed nowadays is because of the development of very effective non-surgical treatments with fewer complications, and also studies demonstrating quite high recurrence rates after surgery.
It is strongly recommended that if you have been advised to have surgical stripping of your Varicose Veins, you seek a second medical opinion regarding whether Ultrasound Guided treatment could be used as an alternative in your particular situation.
What do I need to do before a leg vein treatment?
Waxing or shaving of the legs should be avoided in the 24 hours before any leg vein treatments to minimise skin irritation and any risk of skin infection such as folliculitis.
No moisturiser should be applied to the skin on the day of treatment as small tapes may need to be applied to the skin at the time of treatment.
There is no need to cease any medications before leg vein treatments. Some doctors in the past have recommended that women cease the oral contraceptive before leg vein treatments to reduce the risk of procedure related Deep Vein Thrombosis (DVT), however it is accepted current practice that this is unnecessary. Not only is the risk of procedure related DVT very low, but if women are at high risk of DVT they should not be on the oral contraceptive in the first place. Further, if there is a heightened risk of procedure related DVT, then the risk benefit of the procedure needs to be balanced as to whether the procedure should be undertaken at all, and then if proceeding, strategies such as prophylactic anticoagulant medications need to be considered.
When should I cancel a leg vein treatment?
If you are unwell for any reason it is advisable to defer an elective procedure such as leg vein treatments until you are better. This allows you to recover as fast as possible from your illness, avoids the risk of passing any infection on to others and ensures that your immune system is functioning as well as possible to recover quickly from the leg vein treatment.
It is advisable that leg vein treatments should be deferred until at least 6 weeks after major surgery requiring a general anaesthetic and deferred until 2 weeks after a long haul plane flight (over 4 hours) because these are times of increased risk of DVT.
Leg Vein treatments should be deferred if you are unable to walk after treatment, for example with a leg injury, and also if there is any active skin infection on the legs.
Can I have leg vein treatments during pregnancy?
Generally leg vein treatments are deferred during pregnancy and breast feeding. This is partly because leg vein treatments are less effective during pregnancy, due to an increased pressure in the veins and hormonal changes. Also veins that develop or worsen during pregnancy typically improve after delivery and hence may not need any treatment if you wait until after pregnancy. It has also been suggested by some doctors that as pregnancy is a recognised time of increased risk for DVT it would be unwise to add sclerotherapy as an additional risk factor.
There are concerns surrounding the safety of sclerosing solutions during pregnancy. As a general principle if a drug enters the bloodstream during pregnancy it can potentially effect the baby in unknown ways. Whilst there have been no reports of adverse effects of sclerosants during pregnancy, their safety has not been established. Tests for the safety of drugs in pregnancy are time consuming and costly and there has been no testing of commonly used sclerosants to prove their safety. Hence, it is accepted current medical practice, to not perform sclerotherapy treatments during pregnancy or whilst breast feeding.
During pregnancy the symptoms of Varicose Veins and Spider Veins can be managed by compression stockings and usually we recommend 20-30 mmHg compression.
Surface veins can be treated by Surface Laser or Surface Radiofrequency during pregnancy (as nothing is being injected that can effect the foetus), however most doctors choose to not perform any leg vein treatments during pregnancy and wait until after breast feeding has been completed.
Will leg veins come back after treatment?
The short answer is no, leg veins do not come back after treatment however new veins can form. Whether you treat leg veins or not, if you inherit a tendency to develop veins in the first instance then you will still have a tendency to develop more veins in the future after treatment. It needs to be remembered that even when leg veins are surgically removed, that whilst these veins cannot return, the blood has to go somewhere and it will flow into other veins which will be under more pressure and the valves in these veins can become faulty and more veins can form.
In treating leg veins we are trying to control leg vein disease rather than being able to have a permanent cure. The management of leg veins needs to be thought of as maintenance treatments to control the tendency for more problems in the future (eg like the need to see the dentist to control dental disease).
Can supplements help prevent veins?
In terms of nutritional supplements, whilst there are supplements such as Horse Chestnut that can sometimes help alleviate some of the symptoms from leg veins, such as heaviness and tiredness, there are no supplements that have been scientifically proven to maintain ‘vein wall health’ and prevent Varicose Veins and Spider Veins despite marketing claims.
Where are treatments performed?
At the Melbourne Leg Vein Centre all of our Surface and Ultrasound Guided treatments are performed in our rooms in the Professional Suites of Collins Place. Leg vein assessments, ultrasound scans and all treatments are performed within our rooms without any need for hospitalisation. No general anaesthesia is required for any of our leg vein treatments and patients can resume normal activities immediately after treatment.
The Melbourne Leg Vein Centre is located at the top end of Collins Street (Spring Street end) within the Collins Place Complex. The Centre is well serviced by public transport from trains, with Parliament Station in Spring Street only a 5 minute walk away, and tram stops directly in front of Collins Place in Collins Street. There is metered parking in the surrounding streets of Spring Street, Flinders Lane, Exhibition Street and Collins Street but it is relatively short term and parking inspectors are diligent in this part of the city. There is off street parking in a number of carparks nearby but the Collins Place Carpark is an underground carpark (entrance through Flinders Lane) with the lifts accessing the Ground level directly in front of the Professional Suites where the clinic is located. Car parking tickets for the Collins Place carpark can be validated at our reception area to provide a reduced early bird parking rate.
What can I do after leg vein treatments?
Patients are able to resume their normal activities after treatment. With all leg vein treatments patients are instructed to take a steady walk for 30 minutes immediately after treatment. A daily walk for at least 30 minutes for the next 2 weeks is also recommended. The walking is recommended to get blood moving through the deep veins and to reduce any risk of DVT following treatment.
Vigorous exercise that involves repeated pumping of your legs, such as aerobics or running, should be avoided for at least 48 hours after treatment to minimise bruising.
Strenuous activities that involve straining, such as weight lifting, should be avoided for at least 1 week after Ultrasound Guided treatments to minimise pressure to the deeper veins that might reduce the effectiveness of the treatment.
After surface Laser and Radiofrequency leg vein treatments,(because they involve heating of the skin), it is advisable to avoid sun tanning the treated area for at least 2 weeks. There is no issue with sun exposure following surface Sclerotherapy or Ultrasound Guided treatments.
The recommendations for airplane travel after leg vein treatments vary depending on the type of veins being treated, the type of treatment, the duration of the air flight and whether there are other risk factors for DVT. As a general rule if only surface veins are being treated in a patient not regarded as high risk for DVT and the flight is less than 4 hours, then there is probably no need for any need to avoid plane travel after leg vein treatments. On the other hand, if deep veins are being treated in a patient regarded as at higher risk for DVT and the flight is longer than 4 hours then it would be advisable to avoid plane travel for at least 4 weeks after leg vein treatment.
When do I need to come back after leg vein treatments?
The emphasis in treating surface leg veins is to have an initial course of treatments to get the surface veins under control then periodically follow up in the future for maintenance. In some patients this will be yearly whilst for others it can be many years until any further surface treatments are necessary.
The emphasis in treating deep veins is to use the most cost effective Ultrasound Guided method to control the underlying venous reflux. In more severe cases it may be advised that a regular review is recommended to detect possible recurrences at an early stage.
Which leg vein treatments are claimable under Medicare?
Medicare has an item number for the injection of leg veins, and whether it can be claimed depends on the diameter of the veins, not on whether the veins are superficial or deep, or whether the procedure is by direct vision or by ultrasound guidance. Item 32500 provides a rebate for the injection of veins over 2.5 mm in diameter. Medicare limits the number of times this item number can be used to a maximum of 6 treatments in a 12 month period.
The treatment of veins smaller than 2.5mm does not qualify for a Medicare rebate, irrespective of whether the treatment is by surface sclerotherapy, surface laser or surface radiofrequency. The government will also charge GST on any treatments that do not have a Medicare item number.
The treatment of larger Varicose Veins, by either Ultrasound Guided Radiofrequency (VENEFIT) or by Ultrasound Guided Laser (EVLT), can be claimed under specific Medicare item numbers. These procedures will still usually have significant out of pocket expenses after the Medicare rebate has been claimed.
Out of pocket expenses after a Medicare rebate has been claimed can contribute to the Safety Net. The Safety Net is a scheme under Medicare to limit out of pocket expenses for out-of-hospital services. As of 1 January 2016 the new Single Medicare Safety Net (SMSN) will be introduced. Before the Safety Net applies a threshold needs to be reached and this is $1000 for most couples and families (lower for concession holders). Once the Safety Net is reached then Medicare will pay an additional 80% of any future out of pocket expenses for the rest of the calendar year. The new SMSN system however limits the amount per Medicare service that contributes to the Safety Net (to 150% of the MBS fee for that item number).
Private Health Funds do not pay for out of hospital medical treatments although under extras cover the cost of compression stockings may be claimable.