Varicose veins affect a significant proportion of the population. Many patients suffer ache and are concerned by the appearance of their veins. Some patients will experience complications associated with varicose veins such as thromboses, hemorrhage or venous ulceration.
For many years the mainstay of treatment for larger varicosities has been surgical with stripping or ligation of the feeding vein and stab avulsions of the varicosities themselves.
Thermal ablation of the feeding vein (long saphenous vein or short saphenous vein) has been trialled for some years now. The advent of laser probes and more recently radiofrequency thermal ablation probes has resulted in a procedure that in some studies may rival surgical stripping in its efficacy. Endovenous Thermal Ablation (EVTA) is undertaken by placing a laser or radiofrequency probe into the long or short saphenous vein under ultrasound guidance. Tumescent anaesthesia is induced by injecting a considerable volume (200 – 400mls) of very dilute anaesthetic around the target vein. This provides a degree of anaesthesia but also displaces other structures such as skin, muscle and nerves away from the target vein. Thermal ablation is then undertaken, again using ultrasound guidance, with the tumescent infiltration acting as a heat sink reducing the likelihood of thermal damage to other structures. Employing this technique the stripping or ligation can avoid component of a varicose vein operation. The varicosities themselves will however remain (though under less pressure) and still require treatment with either surgical excision (stab avulsions) or with sclerotherapy at a later date. By undertaking EVTA under general anaesthetic the discomfort of the tumescent infiltration can be avoided and stab avulsions can be performed at the same time thus providing a complete treatment of both feeding veins and varicosities in one procedure. Sunshine Coast Private Hospital in conjunction with Dr Karl Schulze have been undertaking these procedures for some time now with excellent results. The Service is available to both privately insured and non-insured patients.