Do I Need An Ultrasound Scan Before I Have My Spider Veins Treated?

About 25% of people presenting for treatment of telangiectasia or spider veins on their legs will have incompetence of deeper veins.  Proceeding with treatment of surface veins before treating deeper incompetent veins increases the chance of a poor outcome and raises the risk of complications such as post sclerotic pigmentation and matting. Therefore a duplex ultrasound scan of the superficial and deep veins of the leg is best practice in the treatment of leg vein telangiectasia.

 If you are considering treatment of spider veins please ensure your doctor undertakes a thorough ultrasound assessment before proceeding to treatment. Dr Kemp has been certified by the University of Sydney to perform such venous ultrasound examinations at The Leg Vein Doctor clinics in Brisbane and Toowoomba.

Thibault P, Bray A, Wlodarczyk J, Lewis J: Cosmetic leg veins: evaluation using duplex venous imaging, J Dermatol Surg Oncol 16:612, 1990

Sclerosants used in Sclerotherapy for Varicose Veins and Spider Veins (Telangiectasia)

Sclerosants are agents which are injected into veins for the purpose of removing them. The internal vein walls are chemically cauterized and this leads to permanent closure and eventual removal of the vein as it transitions from a fibrosed cord to scar tissue and then complete absorption through a process called apoptosis.

Sclerotherapy has been practised for more than two thousand years as there are records of the ancient Greeks inserting agents through hollow chicken bones pushed into varicose veins. Since then a large variety different agents have been used but in this century it is generally accepted that in the field of phlebology there are only two classes of sclerosing agents which are regarded as acceptable; these being the detergent sclerosants and the irritant sclerosants. 

Detergent Sclerosants.
Worldwide today the detergent sclerosants are the most popular agents in use because of their efficiency and safety record. They also have the distinct advantage of being used in the form of a foam rather than a solution through a simple process of agitating them with air or oxygen or carbon dioxide. The Tessari Method.

1. “Fibrovein”. Sodium Tetradecyl Sulphate.
   Has been in use since 1946 and has been extensively investigated in terms of it’s safety profile.  
2. “Polidocanol”. Aethoxysclerol
   Also in use since the 1940’s and originally used as a local anaesthetic. 
   
   

Irritant Sclerosants.
Often used as an adjunct to the Detergent Sclerosants.

1. Glycerine.
   Glycerine has been in use since the 1920’s and still remains a popular sclerosant around the world. It is a weak sclerosant which makes it only suitable for spider veins (telangiectasia) but it is has a very low risk of causing post sclerotic pigmentation and also a very low risk of skin ulceration.
   
   
2. Hypertonic Saline.
   Pure Hypertonic saline has no risk of causing allergy but it is a weak sclerosant and has now largely been replaced in the 21^st century by the detergent sclerosants. Hypertonic saline has limited benefit in the treatment of larger veins and it has distinct disadvantages in that it causes significant pain if it leaks into the tissue because the vein is missed on injection.  It is also more prone to causing skin ulceration.  Hypertonic saline is also unsuitable in the treatment of larger veins because of the excessive salt load which may cause destruction of red blood cells and also cause damage to the kidneys.

Medicare Rebates for Laser treatment of Varicose Veins.

The Medicare item number for EndoVenous Laser Treatment (ELA, EVLA, EVLT, ELT ) of Varicose Veins in an outpatient clinic is 32520. The precise amount that Medicare will return to patients following ELA is $459.10 not $500 as some patients have been led to believe from recent marketing by other clinics.

The table below is a screenshot of the current MBS table. This has been included to help clear recent confusion about the amount medicare will rebate to patients for this procedure.

Vein Families

A common question at our clinic is "Do Varicose Veins run in families?"  Yes, unfortunately this is true -  if one parent has varicose veins then you have an increased risk. If both parents are affected then you have a 90% risk!

Technically it is not varicose veins that run in families but venous disease affecting the vein walls which damages the valves in the leg veins which then leads to the development of varicose veins. So not all members of the family may actually have visible varicose veins but if their leg veins are incompetent and causing venous reflux then they might be developing problems such as:

•      Aching, swollen or itchy legs
•      Nocturnal cramps and restless leg syndrome
•      Eczema, brown staining or hardening of the skin

If a family member suffers with varicose veins and you have any of these symptoms then it might be recommended that you have assessment of your legs with venous ultrasound.  

What Do You Know About The Person Treating Your Legs?

Being comfortable with the person that is treating you is one of the most important things when choosing where to go to get your varicose veins and spider veins treated. At The Leg Vein Doctor you will only be seen by Doctor Kemp from your first consultation through all your treatments and your follow up appointments.

Nick graduated from the University of Queensland in 1981 and has a long and varied history of working within General Practice. He developed an interest in Phlebology after getting his varicose veins stripped in 1987 only to be disappointed when they recurred soon after.

An article on Dr Kemp was printed in the Mount Isa Star and he also features on the University of Queensland School of Medicine Alumni website.

You can also get to 'meet' Dr Kemp on his YouTube channel before you come to The Leg Vein Doctor.