ACCUVEIN: Is the name of a device to illuminate veins on the surface of the skin. Infrared light is applied onto the skins surface to enhance the visual contrast of the surface veins. The Accuvein has a number of uses including venipuncture and sclerotherapy where it helps target surface veins, but also cosmetic injections on the face where it can help avoid surface veins and help prevent bruising.
AETHOXYSCLEROL: This is a type of sclerosant that can be used on both superficial and deep veins and in varying concentrations (up to 3%) and can be prepared as a liquid or foam solution. Generally it is the preferred sclerosant for superficial veins as it is not as painful to inject as Hypertonic Saline and has a lower rate of skin staining compared to Sodium Teradecyl Sulphate.
AUSTRALASIAN COLLEGE of PHLEBOLOGY (ACP): This is a special interest group of doctors from Australia and New Zealand focused on the treatment of leg vein disorders. Membership includes specialist vascular surgeons, radiologists and also General Practitioners. Phlebology is a subspecialty for doctors from various backgrounds but is not a recognised field of specialty practice. Fellowship of the College is not recognised by the Medical Board of Australia as a specialist qualification.
AUSTRALIAN and NEW ZEALAND SOCIETY of PHLEBOLOGY (ANZSP): This was the first Society in Australia established for doctors interested in Venous disease and was established as a special interest group by the Royal Australian College of Surgeons in 1988.
CEAP: This is a method of assessing and documenting the clinical severity of venous disease. CEAP is the acronym for Clinical, Etiology, Anatomy, Pathophysiology. The assessment method tries to combine the clinical signs (C); the cause of the veins which medically we term aetiology,which is spelt internationally as etiology (E); the anatomical distribution of the veins (A); and what effects the veins are having which we term pathophysiological dysfunction (P).
CHRONIC VENOUS INSUFFICIENCY (CVI): Chronic Venous Insufficiency (CVI) is when longstanding backflow pressure impairs normal arterial blood flow into the legs. This can cause skin changes including brownish pigmentation (staining from iron in the blood) and excema (red,dry,itchy skin). In severe cases it can cause irregular white patches at the ankles (atrophie blanche ), shiny and hardened skin (lipodermatosclerosis) or ulceration of the skin (Venous Ulcer).
CLARIVEIN:Is a variation of Ultrasound Guided Sclerotherapy that combines both a chemical and mechanical method to treat deeper veins. Under Ultrasound guidance a catheter with a rotating inner wire is inserted into the vein to be treated. The wire is rotated to damage the inside lining of the vein wall allowing for the sclerosant that is injected to more effectively seal off the vein.
CLOSURE FAST:This is the name of the special catheter inserted into a deeper vein, through a small incision in the skin, during the VENEFIT procedure. The ClosureFast catheter powered by radiofrequency energy delivers heat to the vein wall and is used to treat large Varicose Veins that previously required surgical stripping.
COLD SCLEROTHERAPY: Cold Sclerotherapy, also called cryosclerotherapy is a method of sclerotherapy that uses cold air onto the skin both before and during sclerotherapy. The purpose is to reduce any discomfort associated with the procedure rather than any enhanced results. The use of cold air cooling is not new and has been used for many years with heat based treatments notably laser treatments. Cold sclerotherapy can be worth considering if a patient has particularly sensitive skin but is not a widely used procedure.
COMPRESSION STOCKINGS: Stockings can be used on the legs to provide compression that help with the return of blood in the leg veins inwards and upwards towards the heart (venous return). Medical grade stockings (hosiery) provide graduated compression that allows for the different diameters of different parts of the leg. Compression stockings can be open or closed toe. The degree of compression in stockings is measured like blood pressure in mm of mercury (abbreviated as mmHg). The usual compression used after sclerotherapy treatments is 20-30 mmHg. This is also the compression recommended for stockings used during long haul air flights to reduce the risk of deep vein thrombosis.
DEEP VEIN THROMBOSIS: Deep Vein Thrombosis, abbreviated as DVT, is when a blood clot develops in the deep vein system. This occurs most commonly in the calf. DVT is a concern because in the short term it can cause pain and swelling and in the long term can cause the Post Thrombotic Syndrome and problems such as leg ulcers. A DVT can be the precursor to a clot breaking off and going to the lungs which is called a Pulmonary Embolism, and this is a medical emergency that can potentially be fatal.
DOPPLER ULTRASOUND: A Doppler Ultrasound uses reflected sound waves from an Ultrasound to evaluate blood as it flows through a blood vessel. How sound waves reflect off moving objects such as blood can be used to measure the speed and direction of blood flow. The word Doppler is named after the Austrian physicist Christian Doppler who in 1842 first proposed the effect of changes in frequency of a wave relative to its source.
DUPLEX SCAN: A Duplex Ultrasound combines Doppler blood flow information with conventional ultrasound imaging information. The Duplex Ultrasound images can be colour coded to show the speed and direction of blood flow on the conventional black and white ultrasound image.
ENDOVENOUS: The word Endovenous means within or by means of a vein. With respect to vein treatments it refers to Ultrasound Guided treatments by injection (UGS), laser (EVLT) or radiofrequency (VENEFIT)
EVLT: Is the acronym for Endo Venous Laser Treatment. This refers to the insertion of a catheter containing a laser fibre inside a leg vein under ultrasound guidance. Laser energy can then be applied to the blood inside the vein which causes the blood to coagulate and seal off and collapse the vein. EVLT is frequently used as a general term to describe all the different types of lasers used for this procedure however strictly speaking EVLT is a term that has been registered by DIOMED who are the manufacturer of the first laser kit used for this procedure. There are now many different makes and models of lasers and laser fibres used to perform this procedure and so terms like EndoVenous Laser Ablation (EVLA) and Endovenous Laser Therapy (ELT) are becoming more frequently used as general terms to describe the procedure.
FOAM SCLEROTHERAPY: The concept of using a foam solution rather than a liquid solution for sclerotherapy was first proposed back in the 1930s but it wasn’t until 2000 when an Italian phlebologist, Lorenzo Tessari presented his method of producing foam that it became very popular. The rationale for using foam rather than liquid is that it is more viscous and better adheres to the lining of the veins improving efficacy, and also that foam sclerosants can be seen on an ultrasound screen unlike liquid sclerosants, allowing for more accurate placement of the sclerosant.
HYPERTONIC SALINE: Is one of the 3 commonly used sclerosants in Australia. For sclerotherapy a 20% concentration of saline is used. The advantage of Hypertonic Saline is that the potential for allergy is exceedingly rare as the active components are the naturally occurring Sodium and Chloride. There is some preservative in the preparation so theoretically someone could be allergic to this but it has not been reported. The disadvantages of Hypertonic Saline are that it has limited effectiveness on larger surface veins; it is quite painful when it is injected; and if it is injected outside of the spider vein it can be quite irritant to normal skin and small skin ulcers can occur. The popularity of Hypertonic Saline as a sclerosant in Australia has dropped since the approval of Aethoxysclerol but it is useful in certain situations particularly strongly allergic individuals.
LASER: The word LASER is the acronym for Light Amplification by Stimulated Emission of Radiation. In essence a laser machine produces an intense beam of light which can be concentrated to produce heat, which can result in effects on what it is directed at. A laser beam can be varied in terms of variables such as the colour of the laser light (wavelength); how long the beam is delivered (pulse duration); how large the laser beam is (spot size) and how quickly the laser beam is repeated (frequency which is measured in pulses per second or Hertz).
LEG VEIN CONSULTATION:A Leg Vein Consultation is an initial consultation with one of our experienced leg vein doctors to assess the nature and severity of any leg vein disorder. As well as a history and a clinical examination, a screening ultrasound examination using a Doppler ultrasound is used to identify any significant underlying venous flow problems.
LONG HAUL PLANE FLIGHTS: Long haul is arbitrarily defined as 4 hours or more and in Australia it essentially means any international air flights. Studies suggest that the risk of flight related deep vein thrombosis (DVT) doubles with flights over 4 hours and it is on these longer flights that measures to reduce the risk of DVT need to be considered.
MAPPING SCAN:A Mapping Scan is a more detailed ultrasound examination of the veins in the leg. It is done to accurately identify and map the position and the degree of any problem with underlying varicose veins. The Mapping Scan especially focuses on areas where the surface and deep vein systems connect such as the groin and behind the knee.
MICROSLEROTHERAPY:When surface leg veins are being treated by injections the term microsclerotherapy is sometimes used to emphasise the very fine needles that are being used, typically 30 gauge but sometimes 32 gauge needles. A 30 gauge needle is similar to the size commonly used for acupuncture.
OHMIC THERMOLYSIS:This is the term used to describe how the ‘Veingogh’ radiofrequency machine treats surface veins. Ohmic is a term that refers to the electrical circuit used in the generation of the radiofrequency energy (which obeys Ohms law of physics which deals with the relationship between voltage, current and resistance) and thermolysis that refers to how the high frequency current produces heat (thermo) to coagulate and destroy the blood vessel (lysis).
PHLEBOLOGY:The term phlebology describes the study of veins (venous diseases). It is derived from the Greek word ‘phleps’ meaning veins and ‘ology’ referring to any science or branch of knowledge.
RADIOFREQUENCY:Radiofrequency is a means of producing heat by a high frequency alternating current. Frequencies are described in terms of cycles per second or Hertz(Hz) and the frequencies for generating heat are very high frequency, in the million cycles/second (Mega Hertz or MHz). A Radiofrequency device can produce a high frequency burst of energy which can be delivered through a fine probe to selectively heat and seal off veins.
REFLUX:In terms of the circulation reflux means backflow, and is most commonly used in reference to venous reflux when blood in the veins flows downwards and outwards rather than flowing upwards and inwards.
RETICULAR VEINS: The word Reticular comes from the Latin reticulum meaning ‘little net’ and means relating to or forming a network. The superficial Varicose Veins that feed into areas of spider veins, and hence form a network of veins, are called Reticular Varicose Veins. When treating spider veins these feeder veins usually also need to be treated for the best results.
SCLEROTHERAPY: Sclerotherapy is the use of an injection technique to treat a vein and can be used in reference to injecting veins anywhere on the body but the commonest use by far is in the treatment of leg veins. Both small spider veins and large Varicose Veins can be treated by this method and leg veins can be targeted both on the surface of the skin or deep below the surface. The term is derived from ‘skleros’ which in Greek means hard and has come about because after a vein is injected the vein seals off and goes hard before the body breaks it down.
SCLEROSCANT: This refers to the solution that is used to inject into a vein in the process of Sclerotherapy. In Australia, there are 3 solutions that have been approved by the Therapeutic Goods Administration (TGA) for use in sclerotherapy treatments. The approved solutions are Aethoxysclerol, Hypertonic Saline, and Sodium Tetradecyl Sulphate. The solutions can be used at varying concentrations and can be used as either liquid or foam preparations
SPIDER VEINS: Very small veins on the surface of the skin are often termed spider veins because the fine interconnecting little veins can resemble a spider web pattern. The smallest spider veins are red in colour and medically we term these tiny blood vessels telangiectasia. Slightly larger spider veins are blue to purple in colour and medically we term these venulectasia. Spider veins can be isolated or can form a cluster in which case it is known as a venular flare.
SODIUM TETRADECYL SULPHATE: One of the 3 Sclerosant solutions approved for use in Australia for sclerotherapy. Can be used in both liquid and foam preparations. Is the stongest of the sclerosant solutions and is most commonly used in Ultrasound Guided Sclerotherapy.
SUPERFICIAL THROMBOPHLEBITIS (SVT): This is an inflammatory condition that affects veins in the superficial vein system due to a clot in the vein. It typically occurs in leg veins but can occur in other areas such as the hands, arms and even neck. It classically presents as a painful, red, hard and tender lump. SVT can occur in anyone but is more common in women, especially during pregnancy or when on the oral contraceptive, and in patients with Varicose Veins. It is also associated with cancers, deep vein thrombosis and patients with conditions that increase blood clotting (Thrombophilia).
SURFACE SCLEROTHERAPY: This term refers to when injection treatments are being used to inject veins on the surface of the skin. Whilst it is most commonly used to treat leg veins it can be used on other areas of the body such as the face, arms and body.
TELANGIECTASIA: Refers to prominent tiny red blood vessels on the surface of the skin. Whilst commonly seen on the face they also can occur on the legs, either in isolation or in association with larger leg veins.
TESSARI METHOD: The Tessari method is technique for producing foam sclerosant that was described by Italian doctor Lorenzo Tessari in 2000. The method involves using 2 syringes conjoined by a 3-way stopcock. By pumping the liquid sclerosant and air back and forth between the 2 syringes generates air bubbles and transforms the liquid into foam.
TRANSDUCER: Is the name of the attachment on an ultrasound that delivers the high frequency sound waves. Depending on the frequency of the transducer will determine the depth of penetration of the sound waves. For example in imaging deep veins a transducer operating at 5-7.5 MHz is used whereas to assess superficial veins a transducer operating at 7.5- 10 MHz is used.
ULTRASOUND: An Ultrasound is a machine that can form an image of structures below the surface of the skin. To form images high frequency sound waves (higher than the human ear can detect) are transmitted from the surface of the skin inwards to bounce off internal structures. The returning sound echoes can be used to form an image of the internal structures including veins. Conventional ultrasound results in 2 dimensional black and white moving images that are called B-mode images.
ULTRASOUND GUIDED SCLEROTHERAPY (UGS): When sclerotherapy is used to treat veins below the surface of the skin, it requires an ultrasound to visualise the veins as they are being injected (ie so the doctor can see where the injection is being placed). This deeper injection is termed Ultrasound Guided Sclerotherapy abbreviated as UGS.
VARICOSE VEINS: The word Varicose means ‘enlarged, dilated and tortuous’. Varicose Veins are much larger blue veins that are graded from Grade 1 to Grade 4 depending on how large they are and whether they bulge above the surface level of the skin (with Grade 4 being the largest).
VEINGOGH:Is a brand of Radofrequency machine that uses a process called ‘Ohmic Thermolysis’ to treat a variety of superficial vascular lesions but in particular spider veins. Microbursts of high frequency energy are delivered through a very fine probe to heat and coagulate blood vessels with minimal trauma to the surrounding tissue.
VENEFIT: Is the tradename of the Radiofrequency device that is used to treat deep veins under Ultrasound guidance. VENEFIT has become increasingly popular as an alternative to surgical stripping operations because of no need for hospitalisation, no need for general anaesthesia, and immediate return to normal activity.
VENULAR FLARE: This is when spider veins form a cluster. It can be fairly localised and resemble a bruise that can be red to purple in colour depending on the size of the blood vessels. On the outer thighs it is common to have a ‘flare’ of veins occurring with a small varicose vein feeding into a circular group of spider veins.
VENULECTASIA: Venule is the name for a small vein and ectasia means dilation or distension of a tubular structure. Venulectasia is used to refer to prominent small veins on the surface of the skin that are purple/blue in colour.
YAG LASER: This is the abbreviation for a Neodymium doped Yttrium Aluminium Garnet Laser which is a type of laser that produces light at a wavelength of 1064 nanometres. When used with pulses in the millisecond range YAG lasers can be used to treat small leg veins. Often needs to be used in combination with sclerotherapy to target larger feeder veins.