This information is provided as a resource and is not a replacement for the detailed and individualised patient information personally provided by Mr Ponosh.
Veins are blood vessels that drain used blood up the leg back to the heart. There are two types of veins in your legs. The deep veins which do the bulk of the work, and the more superficial draining system.
The deep veins are larger veins deeper in the muscles that drain the majority of your legs blood back to the heart. These veins develop conditions such as deep vein thrombosis, colloquially known as “economy class syndrome”.
The skin draining system consists of 2 veins, the long saphenous vein running from the ankle to the groin on the inside of your leg and the short saphenous vein running up you calf from the Achilles to the back of your knee. These veins drain into the deep system. The malfunctioning of these veins is the common cause of varicose veins and are the focus of treatment in many cases.
These veins have no pump but rely on a system of hydraulics moving blood up the leg against gravity. When compressed, blood moves up these veins with one-way valves stopping the blood flowing back down the leg. Under certain circumstances these valves fail or become “incompetent” with blood now flowing up and down the leg. This reverse flow back down the leg causes abnormally high pressure in the veins. The veins cannot cope with this abnormally high pressure and dilate, thus causing varicose veins.
In addition, veins particularly at the ankle are “watertight” at these high pressures and thus become “leaky”. Fluid and inflammatory cells leak out causing many more sinister, non-cosmetic symptoms such as swelling, pigmentation, itching and even ulcers. This is known as chronic venous hypertension.
A common treatment for varicose veins is contemporary open varicose vein surgery. This consists of ligating (tying off) the draining veins in the groin and/or behind knee through a 2-3 cm incision and removing the draining vein to the knee. A number of small avulsion incisions (1-2mm) are then made over the varicose veins to “tease them out”. This is usually conducted under a general anaesthetic at St John of God Subiaco or Hollywood Private Hospital with one nights stay.
Another method often utilised is minimally invasive endogenous ablation using radiofrequency (otherwise known as microwave) ablation (RFA) or laser ablation (EVLT). This involves a more minimally invasive technique in which a catheter passed through the non-functional draining vein under ultrasound guidance. The catheter delivers thermal energy to the vessel wall causing it to contract and collapse.
This is conducted under local anaesthetic in the rooms as an “walk in-walk out procedure”. As discussed at your consultation, whilst the cause of your varicose veins are treated, your varicosities are not directly treated. In many instances they resolve completely following this treatment, however additional injection sclerotherapy may be required for the complete resolution of all varicose veins.
Size of incision for procedure.
The procedure will take approximately 1 hour, although the entire time in the office will be approximately 2 hours.
The procedure will be undertaken in three stages :
Are extremely low utilizing local anaesthetic. Please discuss if you have had any prior reactions to local.
Deep Vein Thrombosis (DVT)
Is a very rare complication manifested as significant pain and swelling. This risk is reduced by a preventative pre-procedure injection as well as maintaining mobility and your stockings.
Please advise us if you have a personal or family history of DVT.
There is usually bruising along the vein that was treated and this resolves over a number of days
This is extremely rare.
These may reflect clotted varicose veins which occur as part of the procedure. This is usually not a concern. Occasionally they may become inflamed (phlebitis) and may require additional minor medical therapy and anti-inflamatories.
In almost all cases it is minimal.
The thermal energy from the ablation can very rarely interfere with the nerves that supply the skin surface can be damaged. This can cause numbness and tingling in the skin. This usually resolves over a few weeks.
New varicose veins can develop and therefore it may be necessary to have further intervention in the future usually with injection sclerotherapy.
Whilst your leg will be dramatically improved by vein intervention, it is impossible to achieve perfection. Additional sclerotherapy or topical laser may be required.
This may occur along the path of the ablation. It is rare and fades in almost all cases over 3-6 months. In some cases it may persist for over 12 months in rare instances.
Failure of Treatment
This is rare. Failure of the technique is reported at less than 2%.
To relieve pain, take simple analgesics such a regular paracetamol
Compression stockings : A form will have been provided to you by the rooms to obtain these stockings PRIOR to your procedure ONLY from the recommended supplier.
To be worn : Continuously for 4 days
Not to be removed for bathing/showering (Hospital Nursing staff will provide advice for bathing options)
Then during the day for 10 days
Contact Mr Ponosh’s Rooms or see your GP if you have :
Remove dressing on day 4 after procedure.
Monitor for signs of infection including redness, swelling, pus and heat. See your GP if these symptoms develop.
A routine ultrasound will be undertaken at 2 weeks. A form will be provided to you for this. We will only contact you following this scan if required.
A letter will be sent to your GP and/or referring doctor advising them of your management.
The rooms will contact you the day following your procedure to ensure all is well and address any concerns.
We will see you in the rooms in approximately 6 weeks following your procedure.
If any concerns arise or you would like to see Mr Ponosh earlier please contact the rooms on 9386 6200 and we will see you as clinically indicated.
Some small residual varicose or spider veins may persist. Mr Ponosh’s will discuss additional management options with you at your follow-up review.