Doctors have treated leg veins with tiny injections for decades, but recent developments have rendered this treatment, termed “sclerotherapy”, safer, more effective, and more comfortable than ever. Spider veins are generally straightforward to treat, but nowadays large varicose veins, that previously required stripping surgery, can also be treated non surgically with injections. Dr. Leat is one of only a small number of doctors trained in the treatment of larger veins by this method. Treatment is quite painless, typically takes about half an hour and is suitable for men and women. There is no interruption of day-to-day activities.

There are now three accepted methods of treating varicose veins; surgery, endovenous laser therapy (EVLT) and ultra-sound guided sclerotherapy (UGS).

Surgical treatment is widely performed but fails in approximately 50% of patients. Surgery leaves scars and may result in damage to adjacent structures, particularly nerves, and involves all of the risks and costs inherent in general anaesthesia. Most patients will require about two weeks off work after surgery and the wait for treatment through the public system can be many many years.

EVLT is a new technique which is only suitable for certain patients – mainly those with incompetent, relatively straight long saphenous veins. Essentially a laser wire is threaded through the abnormal vein and then fired as it is withdrawn – heating the vein and collapsing it. EVLT is expensive ($3-5,000) with no Medicare rebate. It require large volume local anaesthetic around the length of the vein, and further sclerotherapy is often required for branch or residual veins.

UGS is now a widely accepted treatment for varicose veins including long and short saphenous incompetence. Special sclerosant solutions are foamed and injected into veins under ultra-sound control. The foamed sclerosant solution floats through abnormal veins, providing a powerful effect, but is rapidly diluted in faster flowing normal veins thereby sparing them. UGS is therefore very effective at treating complex venous anatomy or tortuous vessels. Compared to other treatments it is inexpensive and safe. Its main benefits include that it is almost painless, takes only 30 minutes, and patients are back to their normal activities immediately. UGS can be especially useful in those who have recurrence after surgery. These patients are often unwilling to undergo further operations after one failed attempt to treat their veins, where repeat surgery is more complex due to altered anatomy and scar tissue.

Smaller veins and spider veins are best treated with standard sclerotherapy. Modern techniques and solutions make this an effective and safe treatment. Most patients find the discomfort quite bearable and the introduction of Penthrox inhaled anaesthesia promises to make it pain-free for all. Unfortunately lasers cannot effectively treat leg veins and can be painful and hazardous.

Dr Christopher Leat at Envisage Cosmetic has performed sclerotherapy and UGS on many hundreds of patients. He offers all patients a free or bulk billed consultation and ultrasound. Colour duplex ultrasound is available onsite.