Complete removal of abnormal veins is our prime objective. Excellent cosmesis is a by-product of very elegant operating skills.

For information on the risks of sclerotherapy please open the attachment

'Ambulatory Phlebectomy'

I remove varicose veins by a method called "Ambulatory Phlebectomy". "Ambulatory" means that the patient can ambulate (move freely) after the operation and walk out of the procedural room. "Phlebectomy means surgical removal of abnormal veins.

Ambulatory Phlebectomy is a modern procedure which could be described as a mini/keyhole surgery. The most amazing feature of this procedure is that most of the small and average sized veins can be easily removed through a tiny puncture, with no visible marks. Only very large veins may occasionally require small incisions and stitches, and as the operation is performed under local anesthetic, there is no pain.

The surgery results in the disappearance of abnormal veins with excellent cosmetic results. Generally there is no post-operative pain, and no complications. As the operations are performed under local anaesthetic, there is no pain. The patient remains conscious and totally in control of his or her body. After the operation is completed, the patient can walk out of the clinic after a short period of rest in the recovery room. The patient can return to normal activities the next day. After two weeks sporting activities including gym exercises can be resumed.

Spider veins

Practically all women are affected by them. The majority are affected with varying degrees of intensity from very mild with a few spider veins here and there; to some with large patches of spider veins and telangiectasia.

From the view point of an average family doctor this is not a medical problem. They don’t make you sick, don’t impair your ability to work unless you are a dancer or stripper!!! They have no influence on ones lifespan. Men are affected only very mildly, they have hairy legs and generally don’t worry about them and even if they do, they don’t admit because it’s not the ‘macho’ thing to do.

Women are different. Some of them are virtually devastated to such an extent that their life is miserable. The psychological impact of spider veins is greater than is generally admitted. Some women become chronically depressed and therefore it becomes not only psychological but a serious medical one.

Being involved in the treatment of spider veins in the initial stages, I learned the technique of micro sclerotherapy and I was performing it very skilfully. However, the longer I used sclerotherapy the more I became convinced about the great deficiency of this method of treatment. I was not entirely happy because of the prevalence of complications, not only in my own practice but also seeing a large number of patients who were unsucessfully treated previously elsewhere. After sclerotherapy, re-canalisation and the reappearance of spider veins is common. And that how Thermo-coagulation was created in my practice.

Treatment of Spider Veins

Thermo-coagulation

Spider veins are treated with a modern method called Thermo-coagulation. An extremely fine insulated cosmetic needle is introduced to the vein and a high frequency electrical current is activated. Electricity travels through the blood vessel, producing an electrical burn, causing the vein to strink and collapse. After treatment there is a small area of irritation along the veins which resolves over a period of a few weeks.

'Mini-Phlebectomy'

Mini phlebectomy is a method of treatment used to remove very fine veins, which could be responsible for supply blood to the areas affected by patches of spider veins and telangiectasia. The technique is similar to ambulatory phlebectomy used in larger veins. However the instruments used are much finer, and veins are accessed only through the puncture of a needle. There are no incisions, and no stitches required. This treatment is combined frequently with Thermo-coagulation.

Facial Veins

Abnormally enlarged facial veins occur more frequently amongst people who are exposed to the extremes of atmospheric conditions, e.g. sun, and cold wind. Alcohol is a great contributor to this condition and they are also present in a condition called Acne Rosacea.

I close the abnormal facial veins by visualising the veins with a potent magnifying glass with polarized light. I use the finest comestic needle to target even the smallest blood vessels. The needle is connected to a machine which produces heat at the tip of the needle which closes the vein. This procedure is repeated many times along the vein until the whole vein is closed. Anaesthetic cream is applied to the face beforehand. Depending on the circumstances more than one treatment might be required.

Risks of Traditional Sclerotherapy

Sclerotherapy (treatment by injections) and especially foam sclerotherapy can, in a proportion of cases, have unfortunate side effects. You should be aware that foam sclerotherapy has not yet been approved in Australia and about the fact that foam travels along the main veins sometimes damaging delicate valves and then to the heart and the brain causing in a proportion of cases unfortunate, serious neurological complications such as strokes, visual disturbances, severe headaches and perioral numbness. Sclerotherapy is no longer part of my practice.

Traditional Surgical Treatment

Former Operations were characterized by prolonged operating time, large incisions and closure of incisions with stitches. So-called ‘stripping’ which is still widely practised today is generally a rough operation. A long segment of vein is removed by pulling it back by wire resulting in the disruption of all its attachments and tributaries. Prolonged hospital stay, excessive pain and extensive bruising are common characteristics of this procedure. There is also a risk of damaging nerves in the vicinity resulting in temporary or permanent numbness. The classical operation of ‘stripping’ was introduced by William Wayne Babcock, an American Surgeon from Philadelphia, who developed an instrument called ‘The Stripper’ approximately one hundred years ago. This is still widely used.

So-called ‘High Ligation’ of the vein in the groin and clearing up of its tributaries might result in disruption of lymphatic vessels. The outcome of impairment of lymphatic drainage is swelling of the legs.

It is my opinion that ‘stripping’ in its classical form generates a message to the body and to the brain that something terrible has happened in the area and that the large vein which should be there is now missing. The long process of reconstruction starts immediately. Unfortunately the attempt at reconstructing the missing vein fails. Small veins lying in the vicinity start to enlarge slowly over the years to compensate for some deficiency. As there is no pre-determined scheme of reconstruction the new veins appear with a vengeance in a typically chaotic way. In some cases, many years after the initial operation, I have seen the legs completely covered with new varicose veins.

In a number of cases the progress of disability is slow but gradual. After many years initially happy patients may find themselves in a situation whereby they have more veins than before. They are also horrified to find that their legs become progressively puffy with grey and bluish discolouration of the skin with myriads of spider veins and telangiectasia. Other complications are pain and tiredness by the end of the day, night cramps and sometimes an unbearable itch resulting in scratching and subsequently infected dermatitis and ulcers.

Patients looking for help and unaware of possible complications may opt for sclerotherapy which might result in temporary closure of visible superficial veins, but the injected liquid might penetrate to the deeper veins, causing thrombosis, damaging delicate valves, increasing puffiness and further restricting the circulation. New veins may appear with a vengeance, this time in the form of ‘blebs’ and so-called ‘pearls’ in a completely irregular fashion. In such a situation further injections could only result in increased deep vein incompetence with very well known complications.