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Surgical stripping of varicose veins has been superceded by newer technologies such as endothermal venous ablation, endovenous cyanoacrylate closure (Glue) and ultrasound guided sclerotherapy which are now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


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



Endovenous Laser Ablation and U

ltrasound Guided Sclerotherapy.

Not hospitalized - Treated as an outpatient.

Appearance at Six months post treatment.

AuthorNicholas Kemp
CategoriesVaricose Veins

We are often asked the question, how safe is EndoVenous Laser Treatment for varicose veins in elderly patients? An international study by veindoctors has shown the treatment is feasible, safe, and well-tolerated by elderly patients.


Varicose veins are a common vascular disease in elderly patients. Both endovascular laser ablation (EVLA) and radiofrequency ablation (RFA) are reported to have good technical, clinical, and patient-reported outcomes for the treatment of varicose veins. We did not find any reports on treating elderly patients with endovascular ablation procedures in the literature. The aim of this study was to determine whether endovenous thermal ablation techniques are safe and effective in treating elderly patients with varicose veins.


A retrospective analysis of 57 EVLA cases and 46 RFA cases was conducted at a single center. Patients in the 65–88-year age group were assessed for postoperative pain, hematoma, thrombophlebitis, hyperpigmentation, wound infection, and skin burn.


Minor complications identified in the studied patients were hematoma (2.9%), thrombophlebitis (5.8%), hyperpigmentation (8.7%), wound infection (4.9%), and skin burn (1%). In the RFA group, 38 patients (83%) had no need for oral analgesic tablets on postoperative Day 3. In the EVLA group, 25 patients (44%) had no need for oral analgesic tablets on postoperative Day 3. Two patients in the EVLA group needed a secondary intervention due to recurrent vein issues. There were no major complications in either group.


The outcomes for our older patients who underwent endovascular ablation therapy were comparable to other studies performed with the general population. Our results show that both EVLA and RFA are feasible, safe, and well-tolerated by elderly patients.

Lam P, Chao L. Endovascular Ablation Therapies for Varicose Veins in Elderly Patients. International Journal of Gerontology, 2014 ; 8 (4) 219–222.

AuthorNicholas Kemp

Varicose veins are twisted, enlarged and swollen veins that are often visible underneath the skin’s surface. They usually appear in the legs or ankles, and are often red or blue in colour. There are numerous remedies (both medical and non-medical) which are used for treating varicose veins, including laser therapy. Lasers are typically used for treating severe cases of varicose veins, where the veins have become excessively swollen, painful and are causing blood clots.

A laser is basically a highly focused beam of light. In the treatment of varicose veins, lasers are used to heat the veins to the point of scarring. This scarring damages the targeted vein and causes it to wither, collapse and close. The closed vein then loses its source of blood and
dies. With time, this vein disappears and is no longer visible underneath the skin’s surface. There are two major types of laser treatments for varicose veins: simple laser treatment and EndoVenous Laser Treatment.

Simple Laser Treatment

Simple laser treatment can be used for treating tiny varicose veins and spider veins (spider veins are extremely minute varicose veins), and for treating veins close to the surface of the skin. To treat the targeted vein, a mild laser is applied from outside the skin and a laser charge applied on the skin over which the varicose vein, or veins, is visible. The objective is to scar the vein without affecting the skin.

To achieve optimum results, the treatment is usually carried out over a number of sessions, and usually scheduled every 6 to 12 weeks. In each session, the affected area is subjected to a laser discharge. The collective subjection causes the varicose vein to dry-up and close. The spacing is to minimise the effects of the lasers on the skin by giving it enough time to heal. 

EndoVenous Laser Treatment

EndoVenous Laser Treatment is used for treating larger varicose veins, especially those that are buried deep beneath the skin surface. Using this method, an incision is made by a doctor on the skin through which a thin tube (catheter) is inserted. The doctor then uses an ultrasound to guide the catheter until it enters the varicose vein and is in the correct position. Once in position, a laser is passed through the catheter and into the varicose vein.

The laser then delivers short bursts of heat energy into the vein. The heat burns up the vein, causing it to shrivel, dry up and close. Using the ultra-scan to guide the process, the entire length of the vein is traversed and the process repeated. The treatment ends when every inch of the varicose vein has been closed. The catheter is then withdrawn and the incision sewn up.

EndoVenous Laser Treatment is usually carried out using either local anaesthesia or a mild sedative. After the procedure, the patient usually feels a little tightness around the area. Sometimes, mild pains or bruises occur, but these usually wear off within a very short time. The procedure is known to have a 94% success rate in closing varicose veins. In most cases, simple laser treatment is used to close up the remaining 6% of the varicose veins.

On the whole, both types of laser treatments are much more effective and carry fewer risks than other treatment options, like the surgical removal of varicose veins. A patient is usually able to resume their normal life within minutes of completing a laser treatment session. Even then, the mild burns and pains associated with laser treatments can be a source of discomfort. As such, it is usually advisable to speak to one’s doctor about the various options available. Generally, laser treatment is recommended for varicose veins which cannot be treated using other non-medical options, like exercise and wearing compression stockings.

AuthorNicholas Kemp