Vein Specialist – Venous Disease Specialist – Phlebologist
Phlebology is an evolving medical sub-specialty devoted to disorders of veins. A phlebologist is a medically qualified doctor who has undergone further post-graduate training to expertly diagnose, treat and where possible, prevent any form of venous disease, whether it be varicose veins, clotting disorders, vascular birthmarks or leg ulcers. Patients with these conditions can seek help by consulting a phlebologist.
Serious interest in phlebology has developed over the last twenty years in Australia and New Zealand, however, it has been an established medical specialty in Europe for more than fifty years.
Up to 30% of the population suffer from varicose veins, or their associated complications. Symptoms include heaviness, aching, burning, stinging, throbbing, swelling, leg cramps and restlessness. The presence of a skin rash on the leg, small blue veins on the feet, lower leg skin discoloration, pigmentation and scarring are usually due to advanced vein problems. If left untreated they can predispose to leg ulcers. Many elderly patients suffer from leg ulceration, the management of which costs the community millions of dollars every year. Prevention can be achieved by treating abnormal veins before ulcers develop.
Blood clots can form in the deep veins causing deep vein thrombosis (DVT). A clot can dislodge to the lungs causing pulmonary embolism which is a life threatening condition. DVT can occur spontaneously, due to inherited clotting disorders, following long-distance travel, after an operation or as a manifestation of an underlying cancer. The acute and chronic consequences of DVT are investigated and managed by a phlebologist.
WHAT SPECIAL SKILLS DO PHLEBOLOGISTS HAVE?
Phlebologists have special expertise in using vascular ultrasound, which assists in the accurate diagnosis and modern management of venous disease. Most procedures performed by phlebologists are ultrasound dependent and phlebologists work closely with vascular sonographers.
Advances in ultrasonic imaging technology along with the introduction of foam sclerotherapy have significantly enhanced the treatment of varicose veins. Phlebologists developed ultrasound guided sclerotherapy (UGS) in 1989 and it has enjoyed greater popularity following the introduction of foam sclerosants in the year 2000. UGS provides a non-invasive, efficient and effective alternative to surgery in the management of varicose veins.
Catheter Directed Sclerotherapy (CDS) is a variation of UGS which was first described in 1997 by Australian phlebologists.
Endovenous Laser Ablation (EVLA) is a new method of treating major veins. EVLA is performed under ultrasound guidance and requires local anaesthetic. EVLA was developed by phlebologists and has gained rapid popularity due to its simplicity and effectiveness.
Less traumatic, minimally invasive surgical techniques such as ambulatory phlebectomy have added to more effective management of varicose veins. This technique requires further training and is performed by phlebologists with a surgical interest.
Many phlebologists perform microsclerotherapy and vascular laser therapy to treat smaller cosmetic veins.
Advances in genetics, molecular biology and new testing methods have increased the ability of phlebologists to accurately investigate, diagnose and manage clotting disorders and in particular DVT. A long-term consequence of DVT is leg ulceration. Some phlebologists run dedicated ulcer clinics in public hospitals or treat ulcer patients in their private practices.
Within the phlebology community are practitioners who have a special interest in vascular birthmarks. By using advanced techniques these abnormalities can now be better diagnosed and treated.
Some phlebologists manage and actively treat lymphoedema and other forms of lymphatic disease.
WHAT FURTHER TRAINING IS REQUIRED TO BE A PHLEBOLOGIST?
Phlebologists must first become qualified doctors by undergoing six or more years of study to gain their medical degrees. This is followed by several years of training in a teaching hospital as a junior hospital doctor and further specialised training is required to gain expertise in this field. Senior Phlebologists may have specialist training in other related fields such as vascular surgery, dermatology or interventional radiology.
The Australasian College of Phlebology has developed a dedicated and comprehensive four-year training program for Doctors who wish to specialize in phlebology. The applicants are required to possess a medical degree and registration as a medical practitioner in Australia or New Zealand. They are also required to have completed at least two years of general training in a teaching hospital. The qualified applicants are then required to pass the Part I Written Examination to gain entry into the Basic Phlebology Training Program. After one year of basic training, they are required to sit the Part I Clinical Examination. If successful they will be certified by the College as Certified Sclerotherapists. Those who wish to specialise in phlebology are required to train further under supervision for another 3 years. A large number of training requirements need to be fulfilled during this period which includes formal training in duplex ultrasound. The trainee is then required to sit the Part II Fellowship Examination. Successful candidates are awarded the title Phlebologist, Fellow of the Australasian College of Phlebology (F.A.C.P.). Many phlebologists travel overseas to further their knowledge and skills through being involved in clinical and experimental research and working alongside their international colleagues. Fellows of the Australasian College of Phlebology must maintain their professional standards through participation in a continuing professional development program that is regulated by the Australasian College of Phlebology.
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