Varicose vein treatment in Cairns

Legs that ache by the end of the day. Heaviness after a long shift. Ankles that swell in the heat and settle overnight. Cramps that wake you at two in the morning. These are the complaints that bring most people to a vein assessment, and the visible veins are often the least of it.

Varicose veins are a sign that the valves inside the leg veins have stopped working properly. That is a mechanical problem with a mechanical explanation, and in most cases it can be assessed in a single visit.

What varicose veins actually are

Veins carry blood from the legs back to the heart, working against gravity. They manage this because they contain one-way valves, and because the calf muscles squeeze the deep veins with every step.

When those valves fail, blood falls back down the vein instead of moving up. This is called venous reflux. Pressure builds in the veins nearer the skin, the vein walls stretch, and the vein becomes wider, longer and twisted. That is a varicose vein.

Most reflux in the leg begins in one of two vessels — the great saphenous vein, running up the inside of the leg from the ankle to the groin, or the small saphenous vein, running up the back of the calf. The veins you can see bulging on the surface are usually branches of one of these. Treating the visible branch without addressing the vein feeding it is the most common reason varicose veins return.

The symptoms that matter

Not all of these appear together, and their severity does not track the size of the veins. Small veins can be very symptomatic; large ones sometimes are not.

The last four are reasons to be assessed sooner rather than later. Skin changes above the ankle, in particular, signal that venous pressure has been high for a long time, and they are the stage before ulceration.

When varicose veins do not need treating

Plenty of people have visible veins, no symptoms and no skin changes. If the assessment finds no significant reflux and nothing in the skin, there is no medical reason to intervene, and it is reasonable to do nothing and review it if things change. Compression stockings, weight management and regular walking are sensible in their own right.

Being told that treatment is not necessary is a legitimate outcome of a consultation.

Who tends to develop them

Family history is the strongest single factor — if both parents had varicose veins, the likelihood is high. Pregnancy is a common trigger, and veins that appear during a pregnancy sometimes settle in the months afterwards.

Occupation matters more in Far North Queensland than people expect. Long hours standing largely still — hospitality, retail, nursing, hairdressing, trades, teaching — loads the venous system in a way that walking does not. Heat and humidity make the swelling and heaviness worse without causing the underlying problem.

A previous deep vein thrombosis is a different situation again, and changes both the assessment and the treatment options.

How the assessment works

The examination that matters is a venous duplex ultrasound. It uses no needles, dye or radiation, and it is the only way to see which veins are refluxing, how far the reflux extends and whether the deep veins are normal.

Scans are performed on site at the Lake Street rooms by our sonographer, Jovin, so the imaging and the specialist consultation happen in the same visit rather than weeks apart.

The scan is done standing, because reflux only shows properly against gravity. A full assessment of one leg usually takes 30 to 45 minutes. Two things help before you come in: leave compression stockings off for 24 hours beforehand, and do not apply moisturiser to your legs on the day.

The findings of that scan determine everything that follows.

Treatment options

There is no single correct treatment for varicose veins. The right approach depends on which vein is refluxing, its size and depth, the state of the skin, and what is troubling you. Suitability for each option is determined by the duplex.

Compression stockings. Not a cure, but they reduce aching and swelling, and they are the mainstay where surgery is not appropriate or not wanted. Graduated medical compression, properly fitted, is different from what is sold in a pharmacy.

Endovenous ablation — laser or radiofrequency. A fine catheter is passed inside the faulty vein and heat is used to seal it closed. Performed under local anaesthetic with ultrasound guidance.

VenaSeal — medical adhesive. A cyanoacrylate adhesive is delivered into the vein through a small catheter to close it. Local anaesthetic, ultrasound guided, performed in the clinic rooms.

Injection sclerotherapy. A solution is injected into smaller veins and branches to close them. Often used alongside one of the above rather than on its own.

Ligation and stripping. The conventional operation, performed in hospital. Still the better option in certain anatomical patterns and in recurrent disease.

Once the faulty vein is closed, blood redirects through the remaining healthy veins. Closing a refluxing superficial vein does not deprive the leg of drainage.

Recovery, in practical terms

Recovery is broadly similar across the minimally invasive options.

A compression bandage stays on for 24 to 48 hours, after which it is replaced with a compression stocking. The stocking is worn during the day, while you are on your feet and exercising, and removed at night. Plan on wearing it for up to a month after your review appointment.

You can return to normal activity straight away, and walking is actively encouraged — aim for thirty minutes a day. Avoid hot baths and strenuous gym work until Dr Freeman has reviewed you. Avoid long periods of sitting or standing still in the first week.

Simple over-the-counter pain relief is usually enough. Avoid aspirin-based products unless they have been specifically recommended for you. Some tenderness along the treated vein for several days is expected, and lasts longer after stripping.

You will be reviewed between one and two weeks after the procedure, with an ultrasound scan to check for deep vein thrombosis.

Contact the rooms promptly if you develop a temperature above 38°C, or pain or swelling that is severe or getting worse.

Risks

Every venous procedure carries risk, and these are discussed in full before any treatment is agreed.

Bruising and tenderness over the treated vein are common and settle over a few weeks. Firm, tender cording along the vein can persist for a month or more. Small patches of numbness can occur where a treated vein runs close to a skin nerve, and are usually temporary. Inflammation of a superficial vein — phlebitis — happens in a minority of cases and is managed with compression and anti-inflammatories.

Deep vein thrombosis after venous treatment is uncommon but is the reason for the routine post-procedure scan. Skin staining or discolouration can follow sclerotherapy and may take many months to fade. Infection, allergic reaction and, rarely, injury to a nerve or artery are recognised complications of any intervention.

Varicose veins can recur. Closing the refluxing vein addresses the problem that exists today; it does not stop other veins developing reflux over the years that follow. Recurrence rates differ between techniques and are part of the discussion when choosing one.

Veins that are purely a cosmetic concern

Fine surface veins — thread veins or telangiectasia — with no symptoms, no skin changes and no underlying reflux on duplex are a cosmetic matter rather than a medical one. Treating them is not covered by Medicare, and it sits under a separate and stricter set of regulatory requirements.

This practice is a vascular surgical practice. Its focus is symptomatic venous disease, venous skin damage and venous ulceration. Where a scan shows nothing that warrants medical treatment, we will tell you so.

Common questions

Do I need a referral to be seen?

A referral from your GP or another specialist is required for a Medicare rebate on the consultation, and it means Dr Freeman has your relevant history before you arrive. Your GP can send it directly to the rooms.

How long will I be off work?

Most people doing desk-based work return within a day or two of a minimally invasive procedure. Heavy manual work and long standing shifts take longer, and stripping takes longer again. This is worth discussing in the consultation, because it depends on your job as much as on the procedure.

Can I fly afterwards?

Air travel in the weeks after venous treatment should be planned in advance so that timing and precautions can be discussed. Tell Dr Freeman about any trip booked within six weeks of a planned procedure.

Does treating my varicose veins help the swelling?

Often, but not always. Ankle swelling has causes other than venous reflux — heart, kidney, thyroid, lymphatic and medication-related — and more than one can be present at once. The duplex helps establish how much of the swelling is venous.

My veins came back after treatment years ago. Can anything be done?

Yes, though recurrent disease is more complex and the assessment is more detailed. A duplex will show whether the original vein has reopened, whether a new vein has become incompetent, or whether the pattern is a network of small vessels at the site of the original surgery.

What happens if I leave them alone?

Many people do, and their veins do not cause serious trouble. But venous disease is progressive in a proportion of cases, and the sequence — aching, swelling, skin staining, skin thickening, ulceration — is well described. Once the skin has changed above the ankle, treating the reflux is about protecting the skin, not about the veins themselves.

Referral and appointments

GPs and referrers: referrals can be sent to the rooms by fax or through the online referral form.

Patients: phone the rooms on (07) 4254 5006, or use the contact form. Suite 9, Level 1, 193 Lake Street, Cairns.