What you need to know about Leg Vein Treatment:
Treatment for leg veins is a key procedure for Geelong Laser Medical Clinic. Here’s what you should know about this treatment;
- Leg veins are very common, occurring in over 50% of people, and can vary from tiny surface veins to large, deep varicose veins.
- The main reasons patients want to treat leg veins are to prevent them worsening and causing problems in the future, unsightly appearance and/or unwanted symptoms such as aching, swelling, tiredness and cramping.
- The choice of the most appropriate treatment requires clinical evaluation by a medical practitioner and often ultrasound scanning to assess any underlying deep vein involvement.
- Nearly all leg vein problems, including large varicose veins, can now be treated without surgical stripping because of effective, less invasive nonsurgical techniques.
- Nonsurgical treatments are either by injection (sclerotherapy) or heat (laser/radiofrequency) and can be applied directly to the skin’s surface or by ultrasound guidance to below the skin’s surface.
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What are the types of leg veins?
Leg veins can vary significantly in size, shape and colour. The smallest surface veins are collectively called spider veins (as the fine interconnecting veins can resemble a spider web). Spider veins vary from the smallest which are red (telangiectasia ) to slightly larger which are blue to purple in colour (venulectasia). When the spider veins form a cluster it is called a venular flare. The superficial veins that feed into areas of spider veins we term reticular veins.
The word varicose refers to enlarged, dilated and tortuous veins. Often the term varicose veins is used to refer to veins that bulge above the skin’s surface, but in medical terms there are actually several grades of varicose veins and when veins raise above the surface level of the skin these are called Grade 3 or 4 varicose veins.
There are two main superficial vein systems in the leg, one on the inside of your leg running from the inside ankle to the groin (the GSV or Great Saphenous Vein) and another from the outside of the ankle to the back of the knee (the SSV or Short Saphenous Vein). These are the main veins that become larger varicose veins when the valves inside these veins become faulty and allow blood to push back to the surface (venous reflux).
When the backward pressure from the deep veins back to the surface veins becomes excessive, this back pressure can compromise the flow of arterial blood and oxygen into the legs and drainage of venous blood out of the legs and can result in swelling and damage to the skin. When this occurs it is called Chronic Venous Insufficiency (CVI) and can result in skin changes ranging from dryness through brown staining, excema (called varicose excema) and even ulcer formation (varicose ulcer).
What causes leg veins?
Leg veins definitely run in families and it may come from either the maternal or paternal side. If both parents have varicose or spider veins there is a higher chance that you will also develop leg veins at some point. Sometimes the tendency to develop leg veins seems to skip a generation so that the history is stronger in the grandparents.
Whilst leg veins can occur at any age they usually start appearing between 18-36 years of age with a peak incidence in the 50-60 year age group. Leg veins have a strong tendency to worsen as we get older presumably because of the cumulative effect of more years on our legs.
Leg veins are more common in women and when men get leg veins they are more likely to be varicose in nature and less likely to be spider veins. Over 50% of all people will develop surface leg veins at some point in their life.
Pregnancy is a time that leg veins typically worsen in women. This is due to a combination of factors including the enlarged uterus causing direct compression on veins in the pelvic area, increased blood volume, weight gain and hormone changes during pregnancy that allow the vein wall and the valves in the leg veins to stretch and become faulty. After delivery, pregnancy related leg veins typically improve although usually do not return completely to their pre-pregnancy state. It is common that with successive pregnancies the veins deteriorate more with each pregnancy and recover back less after each delivery.
People who are involved with long periods of sitting or standing in their daily activities, particularly standing relatively stationary as in occupations such as hairdressing, theatre nurse, surgeon, production line worker etc have an increased risk of developing varicose veins.
Weight gain can aggravate leg veins if you have a genetic tendency but does not seem to directly cause them. Thin people can have leg veins and overweight people can have none, but if you have a tendency to veins, gaining weight seems to worsen the condition.
Can veins be prevented?
Whilst there is no known method of preventing leg veins it seems support stockings may slow the rate of progression in some people if they are used at times of increased risk. Support stockings are definitely worth considering if you have a tendency to leg veins during pregnancy and in occupations or activities that involve long periods of time where you are standing.
It is also known that varicose veins can develop after deep vein thrombosis (DVT), what is termed secondary varicose veins, hence measures to prevent DVT will help prevent these types of varicose veins.
How are leg veins assessed?
To assess leg veins we first do a “Leg Vein Consultation”. This involves seeing one of our medical practitioners who specialises in leg vein disorders ( a phlebologist). The assessment involves a history, examination and Doppler ultrasound scan of the major vein junctions.
Based on this assessment, treatment options will be discussed and it will be decided if the problem can be managed by surface treatments or if further investigation is required with a view to deeper (endovenous) treatments.
If endovenous treatment is required you would be referred to our vascular surgeon who would see you for a “Mapping Scan”. The Mapping Scan involves a colour flow Duplex Ultrasound scan to identify the sites and degree of underlying venous reflux, this then determines which of the endovenous treatments is most appropriate and that would be explained in detail.
What are the treatment options?
Non surgical methods of treating leg veins fall into 2 main categories: either by injection which we call sclerotherapy, or by thermal (heat) and which can be generated by either laser or radiofrequency machines. We consider the non surgical treatments as either targeting the surface veins or the deeper veins.
Sclerotherapy comes from the term ‘scleros’ which means to seal off and ‘therapy’ which means to treat. Sclerotherapy involves using a very fine needle to inject a solution which creates a bruise inside the vein and seals off the unwanted vein. The body naturally breaks these sealed off veins down in the same way the body breaks down bruises. Sclerotherapy is not painful because of the very fine gauge of the needles (usually 30 or 32 gauge) and because of the pH of the solution that is used.
There are two types of sclerotherapy:
- Surface sclerotherapy (also known as microsclerotherapy because of the very fine needles that are used) where surface veins are directly targeted.
- Ultrasound Guided Sclerotherapy (UGS), where a special ultrasound is used so deeper veins below the skins surface can be visualised and then treated without cutting the skin.
Thermal Energy refers to the method of sealing off veins by heating and we can target either surface veins or deeper veins by this method. Thermal energy can be generated in two main ways: either using laser light or radiofrequency energy.
When thermal energy is used to target surface veins it involves using lasers to generate the heat and we call it surface laser. Laser treatment involves the use of a concentrated light beam of a very particular wavelength to specifically target the blood cells and heat up and seal off the veins. This treatment is largely reserved for the very smallest of surface veins. (See Surface Laser).
When thermal energy is used to treat deeper veins the thermal energy is delivered through a catheter inserted into the leg. This involves a minor incision to allow introduction of the catheter, but is done in our rooms and normal activity can be resumed immediately afterwards. This type of treatment is reserved for the more severe of deeper vein problems and is the newer alternative to treating veins that previously required major surgical stripping in hospital under general anaesthetic.
When we use a laser through a catheter to treat deeper veins we call it EVLT which stands for Endovenous Laser Treatment. When we use a radiofrequency machine to generate the heat to treat the deeper veins through a catheter it is called VENEFIT, which refers to the name the procedure has been given by the manufacturer of the radiofrequency machine and catheters.
Where are treatments performed?
At the Geelong Laser Medical Centre we specialise in minimally invasive, non-surgical leg vein treatments. Treatments are all done on an outpatient basis in our rooms either in Geelong or Melbourne. Leg vein treatments are performed without hospitalisation and without requiring any general anesthetics. Patients are able to resume their normal activities immediately after treatment.
All of our leg vein treatments are performed by experienced medical practitioners specialising in surface laser and injection techniques and a vascular surgeon who specialises in ultrasound guided endovenous radiofrequency and injection techniques.