Varicose vein treatment in Perth
Dr Ritter is a highly experienced surgeon who offers all modern modalities of venous treatment. He was fortunate to be trained in minimal invasive venous surgery by one of the pioneers of radiofrequency ablation (RFA), Dr Andrew McIrvine at King’s College, London.
All types of vein surgery are usually very safe and, as an highly experienced surgeon, Dr Ritter will make sure that the risk of any potential complications are minimised. Some complications that can occur with every type of venous surgery are:
Recurrence – 20% likelihood during life time.
Infections – occur in less than 25% of cases.
Swelling of treated legs – rare, but could be permanent in up to 5% of affected people. Sometimes the cause of this is unknown.
Deep vein thrombosis – occurs in less than 1% of cases.
Here are some of the most common ways we treat varicose veins at Ritter Vascular Health.
Endovenous thermal ablation (radiofrequency/ laser)
Minimal invasive endovenous thermal ablation has become the treatment of choice for surgical treatment of varicose veins. It has many advantages over the traditional open surgery (stripping).
Endovenous surgery is a walk-in, walk-out procedure, requires only local anaesthesia, ensures immediate return to work and produces excellent cosmetic results without scarring.
For endovenous therapy, a tiny puncture is made in the lower leg, which does not require stitching and only local anaesthesia is needed. A high-energy fibre (either laser or radiofrequency) is then placed inside the vein under ultrasound guidance. This is absolutely pain free. A special local anaesthetic mix, called tumescence, is then injected around the vein to cool the tissue, compress the vein and deliver anaesthesia. During this process the leg can feel a bit “full”, similar to when getting off a plane after a long haul flight. Heat energy is then used to damage the inner lining of the vessel wall, which will seal it closed.
The end result is an inflammatory process in the closed vein during which the body will literally obliterate the treated segment.
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There are excellent success rates associated with this procedure and lifetime risk of recurrence is only 20% or less. It is common to have one or two sessions of sclerotherapy (injecting a solution to eliminate varicose veins) in the following weeks after treatment to eliminate any residual visible veins.
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Every surgical procedure can have complications. Endovenous surgery is, however, very safe and as a highly experienced surgeon, Dr Ritter will ensure that any side effects are minimised.
Complications can include:
Numbness – this can occur over the treated area. However, it is usually temporary, lasting a few weeks or months.
Bruising – minor black or blue bruises can occur, developing along the inner thigh for up to two weeks after treatment.
Inflammation of veins – the intentional inflammation may cause localised swelling, tightness and tender lumpy areas along the inner thigh. The resulting pain often feels like a pulled muscle. If you take the prescribed post-operative medications, this can be greatly reduced.
Staining – the red blood cells in the treated vein will release their iron content, which the body can only partially absorb. If the vein is very superficial (close to the skin) a light brownish line may be visible initially. However, this will continue to fade over time until it is almost invisible.
Skin burns – occur in less than 1% of cases.
These after-effects are all part of the healing process and are quite normal. They can last between three to six weeks following the procedure.
Foam sclerotherapy
Ultrasound-guided foam sclerotherapy involves injecting a chemical agent known as a sclerosant into the veins. Sclerotherapy has been used in medicine for more than 150 years. Although doable and sometimes indicated, foam sclerotherapy is not a great standalone option to treat truncal incompetence (large varicose veins). However, it is a very effective adjunct to eliminate any minor residual veins after endovenous or open surgery.
With foam sclerotherapy, the liquid sclerosant is mixed with air to create foam. Under ultrasound guidance, it is injected into the varicose vein, displacing the blood within the vein, filling it with the sclerosant. As a result, the vein spasms and scars. The vein is then checked with the ultrasound to measure the success of the injection.
Ultrasound-guidance enhances the accuracy of the injections tremendously and enables Dr Ritter to target specific feeding veins and minimise complication rates.
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As a standalone procedure the success rates are only moderate and early recurrences are quite common. This is because the amount and concentration of foam cannot be controlled after it has been injected.
Furthermore, the foam will choose its own path through the venous system, which is not always the desired, most effective one. However, when the main veins have been treated properly with thermos ablation or open surgery, foam sclerotherapy is a great way to eliminate any leftover visible varices with a durable result that leaves no scarring.
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Every surgical procedure can have complications. Foam sclerotherapy is, however, very safe and as a highly experienced surgeon, Dr Ritter ensure that any side effects are minimised.
Complications of all surgical approaches can include:
Bruising – this almost always occurs after the procedure but will improve in time. Applying bruising creams, anti-inflammatory gels and wearing medical compression stockings will aid recovery.
Skin staining – the red blood cells in the treated vein will release their iron content, which the body can only partially absorb. If the vein is very superficial (close to the skin) a light brownish line may be visible initially. However, this will continue to fade over time until it is almost invisible.
Skin ulceration – occurs in less than 1% of cases.
Deep vein thrombosis with the potential of pulmonary embolism – occurs in less than 1% of cases.
Micro sclerotherapy
Micro sclerotherapy is used to treat telangiectasias (spider veins). This is completely different to foam sclerotherapy to large varicosities as spider veins are tiny skin capillaries that have become visible over the years. It is important to remember that with each treatment, roughly 70% improvement in the treated area can be achieved. This means that more often than not multiple treatments are necessary.
Treatment involves injecting a sclerosant or chemical agent to induce blood vessel scarring and closure. This is done with a micro-needle. There is a good success rate with liquid micro sclerotherapy as 60 to 70% of veins remain closed after one year. Veins often have to be re-injected to improve the success rate. To improve the success rate, treatments need to be spaced out by 6 to 8 weeks.
Reticular veins will recur very quickly if there is an untreated incompetence of the larger veins. Dr Ritter will check this during your first consultation with a duplex ultrasound. If there is no underlying incompetence or this has been effectively treated prior, the recurrence rates are significantly slower.
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Bruising – almost always after your procedure, will improve with time. Wearing medical compression stockings and using anti-inflammatory gels and bruising creams will also aid in your recovery.
Skin staining – up to 60 to 70% likelihood, usually wears off in six to twelve months, sometimes longer. This can be treated with a Q Switch laser if required.
Skin ulceration – occurs in less than 1% of cases.
Mild pain – can persist for several days but shows injections are working.
Superficial thrombophlebitis – this usually settles within 10 to 12 weeks and is treated with compression stockings and anti-inflammatories.
Numbness in the treated area – may take some weeks to months to improve and, in rare instances, may be permanent.
Recurrence of veins – as explained above.
Discolouration and tender lumps – these will improve over 4 to 6 weeks. You may also develop new lumps later due to inflammation.
Headache – extremely rare.
Stroke – extremely rare.
Open surgery
This surgery is classically known as “high tie and strip plus avulsions”. Here the saphenous vein is surgically removed from your leg via a 2 cm incision in your groin, as well as a counter incision at the knee level. Via small incisions over the calf varicosities, those are then pulled out. It involves a general anaesthetic and usually an overnight stay in hospital.
The surgery sounds rather robust and so it is, however, in the long term it yields good results and low recurrence rates.
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Scarring – all incisions will lead to a scar, albeit small. They may be more or less noticeable depending on your skin complexion, the size and location of varicosities, amount of hair on your legs and the way your body scars.
Infection – despite sterile technique there is a 5% risk, especially in the groin.
Recurrence – 20% likelihood in your life time.
Bruising, pain and tender lumps – all patients will experience this. Pain will subside first after days, bruising after weeks, the tender lumps after months.
Bleeding – small risk <5% mostly from phlebectomy sites, which can be easily controlled by pressure.
Deep vein thrombosis – as after every surgery there is a small risk of DVT.
Ulceration – very rare, but can happen if a phlebectomy site becomes infected.