Varicose Veins Procedures
Endovenous Laser Ablation
Sydney Skin & Vein Clinic introduced Endovenous Laser Ablation (EVLA) to Sydney, New South Wales, with our doctors being the first practitioners in Sydney to perform this procedure. EVLA is one of the most effective treatments available for large varicose veins.
The procedure uses ultrasound-guided catheterisation to deliver a fibre-optic laser that ablates the affected vein as it is withdrawn. Performed in our sterile operating rooms under local anaesthetic, no general anaesthesia is required and the procedure takes approximately 60 minutes. Five-year success rates of 90–93% have been reported, with side effects being rare.
Endovenous Laser Ablation (EVLA)
Endovenous Laser Ablation (EVLA), also known as Endovenous Laser Therapy (EVLT), is a significant advancement in the treatment of varicose veins, used in Australia since 1999. Professor Parsi was the first practitioner to perform EVLT in Sydney.
EVLA Procedure
At Sydney Skin and Vein Clinic, we use a local anaesthetic cream to numb the leg before the procedure. We use disposable laser fibers for this procedure.
Ambulatory Phlebectomy
A procedure similar to ambulatory phlebectomy was practiced in Ancient Rome and described by Cornelius Celsus (56BC – AD 30). In 1950 Robert Muller a Swiss dermatologist developed this technique. This procedure is done under local anaesthesia. The vein is removed through multiple tiny incisions. The incisions do not require sutures and the procedure is followed by compression and the patient is asked to walk.
Indications
This procedure is used for the following conditions:
- Varicose veins of the dorsal foot
- Varicose collateral branches of the great and small saphenous veins
- Non saphenous varicose veins
- Veins of the dorsum of the hand
- Infra orbital veins of the face
- Some recurrent varicose veins
Contra Indications
This procedure is not recommended when the patient has a known allergy to local anaesthetic, suffers from ischemic heart disease, poor health and other major chronic medical problems.
Potential Complications of Ambulatory Phlebectomy:
- Bruising and haematoma formation
- Minor bleeding from the puncture sites
- Wound infection
- Damage to the lymphatics- this can cause small lymphatic collections (lymphocele), and lymphoedema nerve damage
- Blood clots including deep vein thrombosis (DVT) or rarely pulmonary embolism (PE)
- Growth of new small veins (telangectatic matting)
- Scars- these may overgrow forming keloid or hypertrophic scars
- Blisters from bandages
- Other nerves can be inadvertently numbed causing a foot drop. This may last 2 to 5 hours
- Allergic reaction or other reactions to the local anaesthetic
Conclusion
Ambulatory Phlebectomy is a useful procedure for the treatment of small varicose veins where the underlying vein has been treated. It is well tolerated by most patients.
General Preventive Measures
Activate your calf muscles (by walking, jogging, running).
This will encourage the muscles to contract, which will stimulate blood flow through the venous system and the return of blood back to the heart.
Elevate the legs when you can.
This will help the return of blood to the heart.
Wear graduated compression stockings.
These provide more compression near the ankles and less further up the limb, which encourages the flow of blood back to the heart.
Avoid prolonged sitting and standing.
Lose weight.
Excess weight can worsen varicose veins and cause both venous and lymphatic problems.
For more information on preventing vein issues , please contact us on
Sclerotherapy
This treatment involves injecting a solution (sclerosant) into small spider veins, causing them to collapse and be absorbed by the body. No anaesthetic is required and the procedure is well-tolerated, with only a brief stinging sensation that settles within minutes. Each session takes approximately 30 minutes, and one to three treatments per leg may be needed depending on your condition. Most patients see significant improvement, with results varying based on age, severity and individual healing.
This procedure uses duplex ultrasound to precisely locate abnormal veins and adjacent structures, including deep veins and arteries. Under real-time ultrasound guidance, a sclerosant solution is injected directly into the affected vein, ensuring accurate delivery and improving both the safety and success of the treatment. Multiple injections along the length of the vein are typically required to achieve complete sealing. Each session takes approximately 30 minutes.
Catheter Directed Sclerotherapy uses a fine catheter inserted under ultrasound guidance to deliver sclerosant along the entire length of an abnormal vein through a single-entry point. Local anaesthetic is injected around the vein to compress it, before the sclerosant is administered as the catheter is gradually withdrawn. This technique is used to treat the lower Great or Small Saphenous veins and other long vein segments, allowing large veins to be treated effectively and precisely. It was developed by Professor Parsi in 1997 and has since been adopted internationally.
We use modern sclerosants approved in Australia, including Sodium Tetradecyl Sulphate (FIBRO-VEIN) and Polidocanol (AETHOXYSKLEROL). These are available in liquid form, however for larger veins treated under ultrasound guidance, they may be prepared as a foam during the procedure. While foam use is considered off-label, international research and clinical experience support it as a safer and more effective option compared to liquid sclerosant.
Results take time - the treated veins will look worse before they improve. In the first month, bruising and discoloration from the injections may last several weeks, and the leg will largely be covered by compression stockings. In the second month, some patients may notice inflammation along the treated vein, which settles with short-term compression and anti-inflammatory medication. From the third month onwards, the vein will progressively soften and fade. Spider veins and small green veins typically clear within 2–3 months, while large varicose veins may take up to 6 months or more to fully resolve.
Daily walking is a critical part of your recovery. A 30-minute walk at a moderate pace each day promotes healthy blood flow and aids healing. However, more is not better, avoid strenuous activities such as running, cycling, aerobics and heavy lifting, and keep your heart rate below 120 beats per minute. Yoga and Pilates involving the legs should also be avoided during the treatment period.
Compression is an essential part of your treatment, helping to minimise bruising, reduce discomfort, prevent blood clots and avoid complications such as staining and matting. Stockings must be worn for the full stipulated period, typically one to two weeks following each procedure. For the first two days, stockings should be worn day and night without interruption, after which they may be briefly removed for a short, cool shower. They should then continue to be worn day and night for the remainder of the first week, and during the day only in the second week. In certain cases, day and night wear for the full two weeks may be required. Following some procedures, compression bandaging will also be applied over the stockings and must be maintained for 48 hours.
To reduce the risk of clotting, avoid flights or journeys exceeding 5 hours within 4 weeks of your procedure. For shorter trips, wear your compression stockings, take regular breaks and walk for 10 minutes every 2 hours.
Early detection of recurrence is important. We follow a strict protocol of follow-up examinations at 6 weeks after completing treatment, and again at 6 to 12 months. Each follow-up includes a fresh ultrasound assessment and clinical examination by your treating doctor.
Certain medications and supplements should be stopped before and during treatment. Some may increase bruising, though this is temporary and will not affect treatment outcomes. Iron supplements can increase the risk of skin staining, which may persist for several months. Female hormones, including contraceptive pills and hormone replacement therapy (HRT), can increase the risk of clotting and matting, and should be stopped at least one month before treatment. Please discuss any medications or supplements you are taking with your doctor.