FAQ: Varicose Veins

Varicose veins are a condition that occurs when the superficial veins no longer function properly. For reasons that are poorly understood, the walls of the veins lose their elasticity and become dilated and elongated. The tissues surrounding the veins cannot effectively support the vein, so the vein becomes large and tortuous. Valves inside the veins, which are designed to direct the blood back to the heart, become incompetent or “leak” so the blood passes backwards down the leg instead of returning to the heart.

These changes result in pooling of blood, increased venous pressure and the accumulation of fluid in your legs. This may progress to clotting in the veins, bleeding from superficial veins, eczema and thickening of the skin and may eventually lead to ulceration in the lower leg (uncommon in uncomplicated varicose veins).

What may happen to untreated varicose veins?:  In the case of large varicose veins, spontaneous blood clots (phlebitis) may develop in these veins.   Also, skin changes including pigmentation, hardening of the skin and underlying fat (lipodermatosclerosis) and eventually ulcers may develop in the lower legs. If you decide not to have any intervention, we strongly recommend you wear compression stockings on a regular basis to prevent worsening of your varicose veins.

Spider veins are mostly cosmetic and may become more prominent with time but rarely cause a problem otherwise.

Recurrence of Veins:  New varicose and spider veins may develop over time, as a patient’s underlying tendency to form varicose veins cannot be changed. These recurrent veins can also be successfully treated.   Factors which may prevent or delay recurrence include maintaining a healthy weight, avoiding prolonged standing, undertaking regular exercise and using compression stockings. Pregnancy usually has an adverse effect on varicose veins, and hormone therapy may aggravate the situation. It is important to take these factors into consideration, however, the basic underlying weakness in the wall of all the veins cannot be changed.

Diagnosis and Management of Varicose Veins:  Dr Peter Bray and Vascular Solutions are proud to be one of the only practices in Perth providing the full range of treatments for Varicose Veins recommended and endorsed by the Royal Australasian College of Surgeons, the Australian and New Zealand Society for Vascular Surgery, the ANZ Society Phlebology and the Australian College of Phlebology.

Dr Peter Bray MBBS (UWA) FRACS (Vascular), Vascular & Endovascular Surgeon, will advise the most appropriate and effective treatment/s for your pattern of venous disease based on the findings of your specialised dedicated venous duplex scan and clinical consultation.

We request that you please read the following information, together with the Royal Australasian College of Surgeon’s “Treatment of Varicose Veins and Other Problems with Veins” brochure which will be provided to you at your initial consultation with Dr Bray.

A brief summary of investigations, treatments and costs follows. Please note the costs in this information are provided purely a guide. In some cases, where patients have complicated varicose veins and financial hardship, fees may be varied.  Our administration staff will advise you in advance of any fees.

Varicose Veins Consultation:  If you have been referred to Dr Bray for the treatment of varicose veins we recommend that you undergo ultrasound investigation prior to your initial consultation. This will save you the time and cost of another consultation following the ultrasound.  You are, however, more than welcome to see Dr Bray first and our Reception staff will make arrangements as you request.

The cost of an initial consultation with Dr Bray is $180.00.  Subsequent consultations are $100.  Discounted pensioner rates are applicable for pension card holders.  If you hold a valid Medicare Card and referral, medicare rebates will also apply.  Dr Bray will advise the best form of treatment for your specific pathology.

Treatment Options:

Surgical Treatment – High Ligation and Strip and Phlebectomies:

Requires a general anaesthetic (or occasionally regional anaesthetic), overnight stay in a private hospital and 2 week recovery period.

Privately Insured Patients: If you hold private hospital cover there is no out of pocket expense for Dr Bray’s surgical fee with most health funds.

Uninsured Patients: Varicose vein surgery is not able to be performed in the public system unless you have “complicated” varicose veins (ulceration, venous eczema or thrombophlebitis).  Please note that there is generally a 6-12 month wait for an operation date and you do not have a choice of dates and procedures may be carried out by surgical trainees under Dr Bray’s supervision. You may elect to be treated as a private patient in a private hospital, however without private health insurance this will incur costs in the vicinity of $4000.00 for the hospital, operating theatre, anaesthetist and surgeon. An estimate of costs can be provided if desired.

Endovenous Laser Therapy (EVLT):

This is a walk in – walk out same day procedure performed under local anaesthesia. It does not require a general anaesthetic, large incisions or an extended recovery period. Most patients are able to return to work the following day.  The government has deemed this an outpatient procedure, therefore the costs are not covered by private health insurance.  There is a Medicare procedural rebate however the significant costs of providing state of the art laser equipment and fibres and our use of sterile equipment and consumables, as well as staff and rooms to ensure your safety, result in out of pocket costs (after Medicare rebate) of approximately $2500 per leg.

Sclerotherapy:

Sclerotherapy is a walk in – walk out, outpatient procedure (approximately 1 hour). It does not require a general anaesthetic or extended recovery period, however multiple treatments may be required.

Sclerotherapy includes microsclerotherapy (also known as direct vision sclerotherapy) for surface veins, through to ultrasound guided foam sclerotherapy for larger primary varicose veins. In some cases this is the sole modality of treatment, or it is used as a secondary course of treatment following surgery or EVLT to “tidy up” any smaller residual veins in areas where it is not safe to perform phlebectomies or laser treatment.  Sclerotherapy is performed by our Phlebologists who are experienced Doctors who work closely with Dr Bray and our sonographers.

The initial consultation fee with the Phelbologist is $140.00. Approximately $70 is rebated by Medicare.  In some circumstances, based on the results of our specialist ultrasound, Dr Bray may be able to determine that your varicose veins will be best treated by Sclerotherapy. If this is the case you may be offered the option to proceed directly to a consultation with our Phlebologist.  Again, this is simply to provide you with the option to save time and money.  You are more than welcome to decline this offer and elect to consult with Dr Bray first.

Out of pocket costs range from $500 – $600 for the first course of treatment. A small Medicare rebate is applicable in some circumstances.

For additional information regarding treatment options, please refer to the following pages: EVLA, Sclerotherapy or Surgical.

Please note that we do not offer “bundle packages” as it is our experience that treatment requirements vary significantly between patients and we do not believe that you should pay for treatments you may not require.

© Vascular Solutions 2007