Considering Choices & Making A Decision
Discussion with Dr. Kornfeld
As you probably heard by now there are several options for the treatment of Varicose and Spider Veins. They include:
- Surgery under general anaesthetic usually as an in-patient in hospital – you may have heard the terms Leg Vein Stripping or Stab Avulsions;
- Laser treatments for larger and smaller veins (using thermal ablation);
- Radiofrequency ablation;
- New mechanical disruption devices;
- SCLEROTHERAPY using medication by very fine small needle technique (with or without ultrasound guidance and with or without foamed medication).
My extensive experience over the past 14 years from the treatment of over 12000 legs using SCLEROTHERAPY and running LEG VEIN CLINIC AUSTRALIA which is dedicated exclusively to the treatment of Varicose and Spider Veins, allows me to speak from vast experience. I will make a few comments on some of the other therapies above, however if you wish to get more extensive information on these modalities of treatment you may search further.
Irrespective of the methods or the devices or technologies used, by far the most important is the expertise and experience of the treating doctor. Personal referrals and word of mouth is an important way to reach a doctor who can give you good results. Most web sites, marketing and advertisements will sound and look good. Many claim extensive experience but fail to be specific regarding the extent of that experience using that particular technique. It is also worth considering whether that doctor does other treatments or is he/she dedicated to leg vein treatment exclusively.
SURGERY has in the past been considered the main treatment for large varicose veins and may still be the treatment of choice in certain less common circumstances. I still refer the occasional person for surgery. Times have certainly changed with advances in non surgical techniques, understanding and results. Surgery almost always as a hospitalized patient involving general anaesthetic is generally the most invasive, physically traumatic option and may be open to the possibility of more complications and down time.
LASERS have been used very effectively for treating small veins on the face – there are many different types of lasers and new ones arrive almost every year. However spider veins on the legs that have been treated with lasers over the years have had more variable results. Although there are new ones brought out every year, the problem with them has been that they often are not able to deal with the larger feeding veins to the clusters of spiders and therefore are not able to obtain the better long term results. To understand this it is much more effective (and also less likely for side effects / complications) to first “reduce mains pressure before trying to fix leaky taps”. The size and colour and depths of leg veins vary a lot and this is the difficulty for any one laser. Also it is important to note that once spider veins are not treated well (or when side effects such as matting are evident), it is more difficult to get a good result with a subsequent treatment. It is best to treat them in the best possible way, the first time. Endo-venous laser is a relatively new treatment most commonly used in the treatment of the large long saphenous varicose vein. The tip has to be introduced through a cut in the skin and inserted up inside the vein. The laser causes thermal (heat) damage as it is pulled out in order to treat the varicose vein. It is reported in the literature to be a good treatment, however is more expensive than sclerotherapy and has side effects and risks as do all modalities of treatment. It is common for people to have a variety of different leg veins for treatment, and so also it is common for people to need sclerotherapy in addition for other veins after their endo-venous laser treatment.
SCLEROTHERAPY has been used as a technique in one form or another for at least 30 years. You may have heard about the use of (hypertonic) saline as the medication from many years ago. This technique has advanced markedly in recent years with the advent of ultrasound examination and understanding how to make it very effective with ALL SIZES OF VARICOSE AND SPIDER LEG VEINS. In addition more modern medication solutions such as Fibrovein and Polydocanol are used (in varying concentrations and volumes for the different size veins), with greater comfort, high degree of safety and excellent results. A 30 gauge (tiny) needle is hardly felt and the medication feeling is described anywhere from hardly anything at all to a stinging sensation for up to 10 minutes. I have even had from time to time the unusual experience of having to virtually wake the patient up to turn during the procedure! Patients often comment during the procedure how they see the varicose vein flatten out as they are watching it being treated. The skill, expertise and experience of the doctor using this technique is paramount for good results as it can be requiring of great precision and “tricks of the trade” that is learned from many years and the treatment of thousands of legs, long after any training or preceptorship was done.
PREVENTION of troublesome leg veins and the long term complications of them, is always so important to consider from a medical, aesthetic, and psycho-social confidence point of view. Unfortunately the most common cause is genetics or tendencies we inherit from our ancestors. The second most common cause (in women) is through the mechanical stresses of pregnancies. So on a lighter note, it is one of the few problems that we can blame both our parents and our children for at the same time! Other causes can be related to a “standing still” occupation, physical injury, high intensity sports, medical conditions, and others. So what can we do? We can have a regular walking programme, maintain reasonable weight with healthy nutrition , don’t smoke, and if varicose veins are starting to appear – treat them early ie nip them in the bud. This especially applies BEFORE AND BETWEEN PREGNANCIES where treating small problems early can prevent them from becoming big problems or increasing medical risks and discomfort during the pregnancy and delivery. In cases where definitive treatment is not possible or has to be delayed, the obtaining of good specific advise re the use of the different types of compression stockings is also important, especially in pregnancy and for travel and certain work.
A LOCAL SERVICE with Leg Vein Clinic Australia is provided by Dr Michael Kornfeld (originally a medical graduate from Melbourne) who lives and works in Northern Queensland and has done so since 2005. Prior to that he had clinics in Brisbane, Noosa and Toowoomba. Being a “local” and being easily available for his patients so they do not have to travel to capital cities or beyond to have an assessment and treatment is an advantage and convenience. It is comforting to know that even in the unlikely possibility of a complication, he is locally based. Routinely he offers to see all his patients within approximately 1 to 2 weeks post treatment.