1. New Treatment Options for Varicose Veins Minimally Invasive Techniques to Remove Varicose Veins Dr. Shannon D. Thomas FRACS Vascular, Endovascular and Renal Transplant Surgeon Visiting Medical Officer Southern Highlands Private Hospital

2. Varicose Veins affect 30% of the human population!!! About 5% will develop venous ulceration Many reasons for treatment

5. Common Reasons for Treatment Pain Discomfort/swelling Thrombosis Bleeding Venous ulceration Appearance Tailor solution to indication

6. Treatment Options 1.Lifestyle adjustments 1.Medical therapy 1.Compression Stockings 1.Sclerotherapy / MicroSclerotherapy 1.Open Venous Surgery 1.Endovenous Ablation

7. Lifestyle Adjustments Avoid prolonged standing Weight loss Increase walking and exercise Workplace seating/ environment

8. Medical Therapy May improve symptoms of varicose veins and may also improve appearance of varicose veins Horse Chestnut Seed ExtractBioflavonoids Ginko ExtractsSaponins Paroven ForteVenotrex AnthogenolVeins Clear Available from most health food stores

9. Compression Therapy

10. Sclerotherapy

12. Open Varicose Vein Surgery

14. Endovenous Ablation

15. RCTs demonstrate less pain, faster recovery and less recurrence than open surgery. On cost analysis, perioperative costs are higher, but total societal costs are lower

16. My Approach 1.Clinical History and examination 1.Duplex Venous Ultrasound: Venous incompetence 1.Duplex Arterial Ultrasound: If no pulses or risk factors Lifestyle and Medical treatments appropriate for most patients

17. Venous Insufficiency with Incompetent Great and Short Saphenous Vein (with or without ulceration) 1.Radiofrequency Ablation and avulsion of varicosities 2.Compression bandage 24 hours, stocking for 6 weeks 1.Back to work next day

18. Venous Insufficiency with a Large Saphenous Vein (>1cm diameter) 1.Open Saphenous stripping and avulsion of varicosities 1.Compression bandage 24hours, stocking for 6 weeks 1.Expect 1 week off work

19. Varicose Veins without Saphenous Incompetence 1.Foam Sclerotherapy - compression stocking for 2 days. 1.Back to work immediately

20. Reticular Veins / Telangiectasia 1.Liquid microsclerotherapy: compression stocking for two days 1.Back to work immediately 1.May require multiple treatments

21. Endovenous Radiofrequency ablation locally Sclerotherapy – performed at St Judes Specialist Rooms (Bowral)

22. Questions?

23. Thank you