In May 2019 the Australasian College of Phlebology conference was in Cairns and guest speakers were invited from all around the world.

Dr Lowell Kabnick from the USA and the Immediate Past President of the American Venous Forum informed us that not one person in the USA had their varicose veins treated by conventional surgical stripping in 2018.

Surgical stripping of varicose veins has been superceded by newer technologies such as endothermal venous ablation, endovenous cyanoacrylate closure (Glue) and ultrasound guided sclerotherapy which are now considered best practice.

before.jpg

60 yr old lady with skin damage from refluxing Great saphenous vein.

after.png

Treatment:

Endovenous Laser Ablation and U

ltrasound Guided Sclerotherapy.

Not hospitalized - Treated as an outpatient.

Appearance at Six months post treatment.

Posted
AuthorNicholas Kemp
CategoriesVaricose Veins

Normal circulation involves blood carrying oxygen being pumped from the heart into the tissues via arteries and then returning de-oxygenated blood carrying other waste products from the tissues back to the heart through the veins. Your arteries might be in good health but if your veins are not working properly and leaking back into the tissues due to varicose veins then in the long term tissue damage to your lower legs can occur leaving you at risk of varicose leg ulcers later in life.  

People with venous disease will often find relief from their swollen feet and ankles and alleviation of tired and aching legs by elevating their legs at the end of the day. There are many and varied medications and devices marketed as circulation boosters (e.g. the brand Revitive™).   Medical Graduated Compression Stockings have Evidence Based Medicine to support their use to improve leg vein circulation and improve leg vein health. Not all stockings are created equal so before you russell up the money to pay top price for a pair check the fit and compression rating, plus sizes are recommended for taller vein patients. 

However, these methods only provide temporary relief and do not prevent tissue damage from occurring in the long term. An Ultrasound investigation can establish if your aching or swollen legs are caused by poor venous circulation. 

Dr Nick Kemp writes a column in Style Magazine educating Brisbane readers on matters of venus health and questions frequently asked by patients at his vein clinic. 

 

Posted
AuthorNicholas Kemp

Spider veins are common, appearing as small blue or red veins seen close to the surface of the skin in the legs and ankles. While spider veins are commonly treated by many types of professions (e.g. beauticians, dermatologists, medispa nurses etc), there are 3 important reasons why you should consider going to a qualified sclerotherapist over any other practice to treat your spider veins.

1. Spider veins may actually be a symptom of underlying venous insufficiency.  

Spider veins, are often associated with underlying venous insufficiency (i.e. varicose veins).  In fact, approximately 25% of patients who present with spider veins have them as a direct result of an underlying  varicose vein insufficiency deeper within the skin. Therefore, the underlying issues of varicose veins must be treated to properly eliminate your spider veins, otherwise they will continue to come back regardless of how often or how many times you treat them. The ability to understand this thoroughly is the most important difference between seeing a doctor whom specialises in venous disease versus those who do not.

2. Sclerotherapists use a Duplex Ultrasound.

As a follow up to the above, in order to eliminate the possibility of any underlying venous insufficiency as the root cause of your spider veins starts with ability to provide a proper diagnosis.  During the initial consultation, the doctor will perform an ultrasound on your legs using a Duplex Ultrasound.  By doing so, they will be able to correctly and accurately map out a treatment plan custom tailored to your particular needs and address an issues that may often be overlooked by going elsewhere.  

3. Sclerotherapists only treat veins. Period.

The most common treatment for spider veins no matter where you go to have them treated is known as Sclerotherapy. Sclerotherapists are required to go through rigorous training so that they can provide safe and effective treatment of your veins. They only treat veins for a living, this is their specialty. More importantly, vein disease is real disease, so why treat it by anyone other than someone with the particular training and acumen required to provide the highest standards of venous care.

Posted
AuthorNicholas Kemp

Spider veins often cause concern because of their unsightly appearance if they become extensive. They can occur anywhere on the body but are most frequently seen on the legs. Telangiectasia is the medical term for spider veins. Incompetent feeder veins or reticular veins deeper under the skin causing “backwash” of blood back into the skin are the usual cause.

Gold standard treatment is sclerotherapy. Vascular laser is rarely indicated for the treatment of telangiectasia on the legs.

However for the treatment of varicose veins Endovascular laser is often the first step in treatment.

Sclerotherapy usually requires a number of sessions for optimal results.

Before

Before

After. At 3 months. Sclerotherapy 2 treatments.

After. At 3 months. Sclerotherapy 2 treatments.

Before

Before

After. 6 Months Sclerotherapy 4 sessions.

After. 6 Months Sclerotherapy 4 sessions.

Before

Before

After - 3 months. Sclerotherapy 2 treatments

After - 3 months. Sclerotherapy 2 treatments

Posted
AuthorNicholas Kemp

You've noticed blue, red or protruding veins on your legs…. what goes on inside the body to lead to the formation of these veins and can and how are they treated?
 
What's happening below the skin that can't be seen to the naked eye?

Your body continually works hard to ensure optimal blood circulation - this keeps  your body running smoothly. Arteries circulate oxygen-rich blood from your lungs around the rest of your body, it's the veins which push the blood back to your heart against gravity using a network of one-way valves and surrounding muscles. As you walk the calf muscles act like a pump and compresses the deep veins pushing the blood back up the leg. Superficial veins rely entirely on the ability of the valves to prevent backflow to your feet. This is where people with varicose veins have a problem.

How does this create varicose or spider veins?

In varicose veins the valves, which are supposed to open and close consecutively, do not work properly.  When the valves do not function properly, the blood begins to pool in the vein, which makes it difficult for the muscles to push the blood up for legs. Instead of flowing consecutively from one valve to the next, the blood continues to pool in the vein, increasing arterial venous pressure and the increasing likelihood of congestion while causing the vein to bulge and twist. Because superficial veins have less muscle support than deep veins, they are more likely to become varicose or spider.

What’s the difference between varicose and spider veins?

While both Spider and Varicose veins occur mostly on the legs, their appearance is the easiest way to tell them apart.

Spider veins (Telangectasias) are smaller in comparison to varicose veins. They have a diameter between 1 mm to 3 mm and generally appear in small areas just underneath the surface of the skin. They are usually purple, blue or red in colour and have an appearance like a spider’s web or even a linear pattern. Spider veins are often caused by the backup of blood, hormone changes, exposure to the sun, and injury.

Varicose veins on the other hand are much larger due to the pooling of blood in the vein. They are also very bulky in appearance, often similar to thick ropes that protrude and bulge pushing the surface of the skin upwards.

Will I get spider or varicose veins?

There are many factors that presidpose a person to varicose veins and spider veins. Varicose and spider veins are seen more often in women than in men. Some of the more common factors that induce varicose veins include:

  • Genetics . Family history is one of the most common reason for weak vein valves which can inevitably increase your risk. Approximately half of all people who have varicose veins have a family member who has also had them.

  • Weight Gain. Excess weight and obesity can put extra pressure on your veins which may lead to varicose veins.

  • Hormones. During puberty, pregnancy, and menopause women often develop varicose veins due to changes in the production of progesterone and other key hormones. Find out more about these changes during pregnancy and menopause.

  • Immobility. Sitting or standing for a long time may force your veins to work harder to pump blood to your heart. This can be a bigger problem if you sit with your legs bent or crossed.

  • Age. Often the older you are the more common the condition, over time the valves in your veins may weaken and not work as well.

  • Sun exposure. This can cause spider veins on particularly on the face of those with fair skin.

An Ultrasound examination is always performed at the clinic on all patients to assess the competency of all the superficial and deep veins in your leg due to the is a close relationship between the development of spider veins and varicose veins. Up to twenty percent of people with spider veins have underlying incompetent Saphenous veins and ultrasound allows us to detect this. Failure to detect underlying incompetence of superficial veins or saphenous veins leads to much greater complication rates in the treatment of surface veins

Posted
AuthorNicholas Kemp

Many people suffering from varicose veins know that they have them because blue ropey veins can be seen bulging through the skin on their legs. Others may report a discomfort or feeling of heaviness which alerted them to the fact that they could have venous disease.

Obesity can mask the symptoms of the failing valves because the swollen veins are often hidden.  Aching in the leg might be attributed by patients to the extra weight they are carrying rather than hidden varicose veins.

Many of my patients carrying excess weight are only alerted to the fact that they might have varicose veins once skin damage starts to occur. Varicose veins left untreated can lead to leg ulceration. 

With overweight patients it can also be more of a challenge to assess and treat the problem because the veins can be deeper within the leg making it harder to map and properly access and identify the diseased veins.

This article was published in Brisbane Style Magazine November 2013 - Dr Nick Kemp is regular contributer on the Ask The Experts Panel.  

Posted
AuthorNicholas Kemp