Spider Veins

  • Smallest of veins
  • 1 mm or less in diameter
  • Usually not cause of pain
  • Generally genetic origin but may be due to certain drugs, hormonal changes, pregnancy

“Case Study: Kate”

Kate is a 28 year old, who has always had very small, fine red veins on her legs.  Due to her having fair skin these were quite noticeable. They don’t cause her any pain but are unsightly.  She’s not sure how they are treated and her GP has referred her but she never received a satisfactory answer.  She has researched on the internet a little and is interested in visual sclerotherapy (See Procedures).

After the treatments which involved several needles, and the application of stockings for 3 days, she started noticing some changes.  Initially there was quite a bit of bruising, but over the next 3~ 6 weeks they started to fade and those spider veins never came back.  Yes there were some very fine ones still that were too small for even the needles, but overall she was happy with her outcome.
*Case studies serve as examples of patient experience, and are not to be taken as exact outcomes.  Individuals vary in their experience and outcome and no absolute guarantees can be made.

Varicose Veins (non-truncal)

  • Mid-size to large veins
  • 2.5 mm or greater in diameter, up to 8mm
  • Can cause pain
  • Blue – dark appearance
  • Can be genetic, or due to incompetent valves, deep vein thrombosis, chronic reflux disease
  • Variable severity

“Case Study: John”

John is 53 year old.  He has suffered from varicose vines all his life.  Initially they were just blue spots on his leg but now seems to be getting worse.

They aren’t long ones but are spotty over the front of his shins.   They ache from time to time and has been getting larger.  He also has a little osteoarthritis of the knees from the old rugby days but panadol helps.

He decided to get this treated and set up an appointment with vein specialists.   He was adviced to have visual sclerotherapy and ultrasound guided sclerotherapy, after detailed venous mapping.

He had one consults session, and 2 treatment sessions.  Six weeks after the treatments and being in stockings for 3 weeks, most of the varicosities have gone.  There are some spider vein (telangiectasias) in situ but he is not concerned about appearance so doesn’t want them treated.
*Case studies serve as examples of patient experience, and are not to be taken as exact outcomes.  Individuals vary in their experience and outcome and no absolute guarantees can be made.

Incompetent Vein Valves (and Perforator disease)

  • All veins have valves to provide uni-directional flow (towards the hard)
  • Valves decrease in frequency the closer you come to the groin
  • Valves also separate the superficial from deep veins (so called perforators)
  • Can cause pain
  • Can be genetic, or due to incompetent valves, deep vein thrombosis, pregnancy
  • Variable severity

“Case Study: Lindsay”

Dilated blood vessels

  • All venous blood vessels can dilate
  • When it is above normal diameter they can be considered varicosities
  • Varicosities can occur not only in leg veins, but also other parts of the body (brain, stomach, liver, anal region)
  • Bad disease eventually lead to pain, leg skin changes, and ultimately ulcers.

“Case Study: Ryan”

Ryan is 23, and has always had some very fine, but also not so fine, veins on his thighs and shins since teenage years.  They haven’t cause him much trouble previously but now as some are gradually enlarging.  He approaches his doctors who advice him to seek further help.

At initial consult, after a thorough history and examination, and subsequent ultrasound mapping, he is found not to have large (so called truncal) disease, but many dilated varicosities, beyond 2.5mm in size.  He is happy to know that he can have these treated with sclerotherapy which is also MEDICARE rebatable, so it does not cost him too much.

After 3 sessions of injection, and many weeks in his stockings (three weeks after each session), most of his veins have disappeared.  He has some initial bruising however these went away after 2 weeks.  He is overall quite happy with how things went.

*Case studies serve as examples of patient experience, and are not to be taken as exact outcomes.  Individuals vary in their experience and outcome and no absolute guarantees can be made.

Skin Changes due to Varicose Veins

  • Mild pigmentation from haemosiderin (rusty brown breakdown produce of red blood cells)
  • Areas of inflammatory change and eczema (like dermatitis).
  • Lipodermatosclerosis – inflammation of the subcutaneous fat causing fibrosis (thickening of tissue), and hard, tight skin which may be red or brown.
  • Atrophie Blanche – star-shaped, white (ivory), atrophic areas of skin surrounded by reddened areas.
  • Ulceration (open patch of superficial skin loss).
  • Due to increase in venous pressure in the legs.

Case Study: “Becky”

Becky is 62 years old. Due to her sedentary lifestyle, she has been putting on a lot of weight. She has for sometime had lower leg soreness and itching.  In the past she had applied some ointments which failed to provide relief. Her condition further deteriorated over several years, eventually her legs became swollen, darkened red in appearance, shiny, and markedly thickened. Something had to be done.

Her daughter who was a nurse provided basic home care advice such as avoiding direct trauma to the skin by wearing simple stockings. She knows this may very easily lead to ulceration. Her legs were elevated whenever possible, and she was told to be physically active and encouraged to walk regularly. Eventually she heeded her daughters advice to see a vein specialist. Becky explained it started over or just above the right ankle and there was a family history of bad veins.

The specialist assessed her with a thorough history and physical examination, and performed a duplex ultrasound scan.  He explained that being overweight worsened the reflux in her veins, and that she had bad truncal (large vein) disease.  This was finally treated with MOCA (ClariVein) and two courses of sclerotherapy. Neither procedure was uncomfortable. While most of the swelling settled the skin staining remained. Becky is not too concerned with the look as long as the itch is gone.  She also agreed with her doctor to enter a weight loss program.

*Case studies serve as examples of patient experience, and are not to be taken as exact outcomes.  Individuals vary in their experience and outcome and no absolute guarantees can be made.

Ankle Ulcers from Varicose Disease

  • An open sore or lesion on the body that is slow to heal or keeps returning.
  • Usually painful.
  • Generally three types of non-traumatic ankle ulcers: venous stasis (most common), neurotrophic, and arterial ulcers.
  • Due to a condition called venous hypertension or chronic venous insufficiency.
  • Risk factors: family history of ulcers, people who smoke, and those with previous vein conditions

“Case Study: Jack”

Jack is 57 years old. He has been smoking more than 2 packets a day for the last 30 years.  He has chronically suffered from burning and itchiness on both his ankles.  Two months ago he grazed his right inner ankle on a desk at work.  Since then there has been an open ulcer, and the skin has been unable to heal.  He finally sought medical help.  At assessment his skin was warm to the touch, there was significant swelling in the skin around the ulcer, and obvious red discolouration.

After a thorough history and examination, with ultrasound mapping, he was diagnosed with having a large varicose vein underlying this chronic, non-healing venous ulcer.  He subsequently had Ultrasound Guided Sclerotherapy, with compression bandaging for 3 weeks.

When he presented a couple of months later, the skin had finally healed.

He swore to this day he has not gone back to smoking.

*Case studies serve as examples of patient experience, and are not to be taken as exact outcomes.  Individuals vary in their experience and outcome and no absolute guarantees can be made.