Is sclerotherapy the best option for your veins?
What is sclerotherapy and how is it used?
Sclerotherapy is a medical procedure used to treat varicose veins. A solution of vein irritant is injected directly into the affected veins using ultrasound guidance. This causes them to collapse forcing blood to re-route through healthier veins. The collapsed veins are reabsorbed into the body and eventually fade. Sclerotherapy is a precise, minimally invasive process. It's known for being effective and having a quick recovery time. We usually offer sclerotherapy either as your main varicose vein treatment or in combination with closing down the main feeding vein. Sometimes, after varicose vein treatment, you will need some sclerotherapy to tidy up any remaining small varicose veins.
When is sclerotherapy used instead of other vein treatments?
Sclerotherapy is a common component of most varicose vein treatments. Some patients will only need sclerotherapy for their vein treatment but many patients will also need treatment for a leaking surface vein. This treatment will usually involve a sealant treatment (Venaseal) or a heat treatment such as laser/radiofrequency. All of these vein treatments have been shown to be equally effective and safe. Almost all procedures take about 30-60 minutes, are minimally invasive and the patient is awake throughout.
Microsclerotherapy is also used for spider veins and very small varicose veins. When the remaining spider veins are too small to be treated with microsclerotherapy, we recommend laser therapy for treatment. Laser therapy uses focused light to heat and damage the veins, causing them to slowly disappear.
A combination of both treatments may be recommended to achieve the best results.
How do you know if you have varicose veins?
Usually varicose veins are visible and patients already know what they are from their appearance and their symptoms. To find out the cause of varicose veins, an ultrasound scan guides the vascular specialist to where the varicose veins are being fed from. Sometimes clusters of spider veins are an indication that underlying varicose veins are the cause. An ultrasound scan scan will determine if this is the case.
Consulting with a vascular surgeon is essential to determine the best treatment plan and the best method of treatment if you have varicose veins.
What you need to know about health insurers – will your varicose veins be approved?
Most health insurers cover varicose veins, ultrasound, skin lesions and arterial conditions, with certain medical criteria. In brief, these medical criteria may include:
- symptoms for varicose veins like aching legs and bulging veins, ulcers, varicose eczema
- the ultrasound conducted as part of your varicose vein treatment or for patients on a surveillance programme, eg, to monitor an aneurysm
- the need for biopsy, cryotherapy or excision for skin lesions.
Note: You do not need a general practitioner (GP) referral for our vein, ultrasound or skin lesion treatments. Some providers ask for a letter for prior approval.
For arterial conditions you will usually be referred to us by your GP. Spider vein treatment will not usually be covered on its own, unless it is in conjunction with your varicose vein treatment, involving sclerotherapy. Most insurers consider spider vein treatment is a cosmetic condition.
We work with many insurance providers in New Zealand, including Southern Cross, Partners Life, NIB, Accuro, AIA and NZ Police Welfare Fund. These insurers work with specialists like us as affiliated providers, which means the processes for approval and pre-approval will help to speed up your claim. We are trusted specialists these insurers rely on and you can, too.
Check your policy's terms and conditions before claiming
Treatment covered by your health insurer will depend on the cover you have chosen. Whether you can get treatment in the public system is also a consideration. If your GP has referred you we will provide a letter recommending whether you need treatment or not. Generally, if we recommend treatment, and your policy covers it, you can apply for cover. If we have affiliated status with your insurer we can do the paperwork for you.
Please check your policy terms and conditions and eligibility criteria. In addition, check your policy for exclusions, existing conditions, eligibility, what your excess or shortfall will be (an amount you will need to pay yourself, if applicable) and how to apply.
Health insurers' policies – what are you getting?
Most insurers offer a number of policies so you can choose what suits you and personalise some add ons. You can often choose the excess you will pay if you make a claim down the line. Policies may be for hospital only cover or cover for all general medical expenses, like GP visits. Many offer a combination of both policies. Following on from this, Partners Life insurer explains some of the differences here.
You can buy private health insurance directly from a health insurer in New Zealand. Often you can do this online or through an independent financial broker. For some people health insurance is also available through their employer, for example, the Police Welfare Fund.
The websites of the major health insurers in New Zealand provide comprehensive information. One-to-one customer service is usually available to answer queries about your claim.
Running? Team sport? Find out how to manage varicose veins
Varicose veins can affect your running and team sports. Though the extent varies depending on the severity of them and the type of sport you play.
Varicose veins occur when the valves in the veins, usually in the legs, become weakened or damaged, causing blood to pool and the veins to enlarge.
Are any of these symptoms affecting your enjoyment or taking part?
Some people with varicose veins have aching, heaviness or cramping in their legs, which can be worse when running and playing sport. Your legs may feel more tired. Running may increase blood flow to the legs, and in severe cases of varicose veins, this may cause swelling, which could make running in general uncomfortable. High-impact sports may increase swelling in the legs, too making them feel heavy or tired more quickly. You may find you have less endurance than you used to have and less agility. This can be distracting or limit performance in sports that need a lot of stamina, like squash or basketball.
Varicose veins can make it harder for the body to pump blood efficiently back to the heart, which may mean you fatigue more quickly during sport. Especially when playing sports with long bursts of activity like rugby or hockey.
Some people might feel weakness or instability in their legs. This may increase the risk of falling or injury in sports that require quick direction changes, jumps or sprints.
In some cases, varicose veins can lead to more serious complications like blood clots (thrombophlebitis), which can make running and playing sport more painful or unsafe.
Prolonged venous insufficiency can lead to skin discoloration or ulcers around the veins, which could become irritated by your sports shoes or clothing. Especially if you’re running long distances or playing sport for long periods and sweating a lot.
Varicose veins in the legs may also be unsightly. You may be self-conscious when playing sports.
Tips for playing sport if you have varicose veins:
- Wearing compression stockings can help improve blood flow and reduce swelling and discomfort while running.
- Make sure you have supportive shoes with good arch support to help reduce leg strain.
- Stretching, warm ups and warm downs can help improve blood flow and reduce strain on the veins. This is good advice for all athletes.
- Staying well hydrated and elevating your legs after a run or sport can help reduce swelling.
- You may need to consider reducing or changing your sport – running shorter distances, spending time on the sidelines. Lower-impact activities like cycling or swimming can help reduce the stress on your legs. Remember to rest up after activity.
If your varicose veins are causing a lot of discomfort, it’s a good idea to consult with your GP or vascular specialist. They will recommend treatment options for you.
Focus: find out all about Ehlers-Danlos Syndrome (EDS)
What is Ehlers-Danlos Syndrome (EDS)?
Ehlers-Danlos Syndrome is a group of inheritable disorders that affect the quality of connective tissues supporting the skin, bones, blood vessels and organs. Genetic changes affect connective tissues by altering collagen in the body.
What's more, depending on the type of EDS, the gene causing EDS may have been inherited from one parent or both parents.
What is connective tissue and collagen?
Collagen is a protein found throughout the body, where it supports, protects and provides structure to other parts of the body. And is the main building block of the body.
EDS is caused by changes in the genes that affect the structure and function of collagen. It causes changes in the amount, size, shape and organisation of collagen.
Hypermobility is the most common form of EDS
Hypermobility syndrome is the most common form of EDS (hEDS). Making up 90% of EDS cases. Joint hypermobility, or 'double-jointedness', is typical. But other body systems may also be affected, such as the heart and arteries, nerves, skin, muscle and spine.
Other conditions include generalised Hypermobility Spectrum Disorder (G-HSD), Loeys–Dietz and Marfan syndromes and Osteogenesis Imperfecta, with EDS and G-HSD the most common.
Symptoms can range from mild to severe. For example, chronic and widespread pain, fatigue, nerve and gut problems are common. Affected people will often be treated for other illnesses, such as irritable bowel syndrome and indigestion.
Just how EDS and the other disorders are linked to vascular compression syndromes is not currently known. With more research needed. In fact, vascular compression is mostly picked up when people are scanned for another reason. And, therefore, show no signs of vascular compression at all.
How to diagnose EDS
The genetic cause of the most common EDS subtype – hEDS – has not yet been found. Therefore, there is no genetic test currently available. As a result, diagnosis relies on certain diagnostic criteria. This includes the Beighton Score to assess for hypermobility. Formal diagnosis is by a rheumatologist.
Management of symptoms
There is no cure for EDS. Management involves addressing each person’s symptoms. Physiotherapy and pain management, as well as using equipment, such as splints for hypermobile joints, are all helpful therapies. Those that help to improve quality of life are essential. Monitoring of blood vessels by ultrasound scan is beneficial for some sub-categories of EDS.
Hormones, such as progesterone and oestrogen can heavily affect those with EDS. In addition, prolonged menstruation and dysmenorrhea is often reported by women with EDS.
Increasing awareness about EDS is essential for early diagnosis and better support.
Finally, advances in genetic sequencing and understanding of collagen biology offer hope for targeted therapies that could help reduce symptoms and improve outcomes for those with EDS.
Pelvic vein care, chronic pain and finding out about treatment
Symptomatic pelvis veins are relatively common in women who have had children and may be a cause of chronic pelvic pain. This is called pelvic congestion syndrome. Pelvic varicose veins may be the cause of chronic pelvic pain in up to 30% of women.
Pelvic veins are varicose veins around the uterus and ovaries. Abnormal pelvic veins allow blood to pool in the pelvis, rather than being returned to the heart, and cause pressure symptoms. Sometimes they may escape the pelvis and cause varicose veins around the groin and in the legs.
Some of the symptoms of pelvic veins may include:
- A heavy dragging feeling in the pelvis, worse when sitting
- An urge to pass urine frequently
- Pain during intercourse
- Groin/vulval/labial veins first appearing in pregnancy, improving after birth then coming back in the next pregnancy
- Veins that started in the groin and moved to the upper, inner or back of thighs
- Unexplained pelvic pain even though you’ve been seen by other specialists.
Our dedicated pelvic vein care nurse would be happy to discuss pelvic veins with you. She is available on 0800 45 45 88.
If it is likely that you have pelvic veins, our nurse will discuss this with our specialists. Often you will need an ultrasound scan and possibly a CT scan to confirm the diagnosis. We will organise these investigations for you.
Sometimes other causes of the pain are discovered during these scans. If you do not have pelvic veins our nurse will discharge you back to your GP after discussing your details with our specialist. Sometimes a referral to another specialist will be needed, and this will be done in conjunction with our specialist and your GP.
Next, your treatment plan
If you do have pelvic veins that have been confirmed on the scan(s), an appointment will be made with our specialist and a treatment plan will be recommended. Your diagnosis will most probably be pelvic congestion syndrome or atypical leg varicose veins that emerge from your pelvis.
What is ovarian vein embolisation?
Ovarian vein embolisation is the most common form of treatment for pelvic veins. This is a minimally invasive treatment that is performed under X-ray guidance. The leaking ovarian veins are closed off with small coils and by introducing a vein irritant (sclerotherapy) into the branches that arise from them. This closes the veins so they can no longer enlarge with blood, thus relieving symptoms.
Our team will be back in touch to book your treatment day. Your treatment will be at modern Wakefield Hospital in Wellington and is a day-case procedure.
Pelvic vein care – about the procedure
Once admitted, a sedative will relax you. You will still be awake during the procedure. Local anaesthetic will be injected around the access site. A catheter is inserted into the problematic vein(s). Coils are inserted to block off the varicose veins, which stop blood flowing through them. The number of veins needing to be treated will determine the length of the procedure. Sclerotherapy is usually performed at the same time. A small amount of varicose vein irritant is injected in the varicose veins in the pelvis.
After the procedure
After your procedure you will be monitored for several hours. You may experience some pelvic discomfort and this can be relieved with pain medication. You cannot drive yourself home and may need to stay in Wellington for the night if you are from another region.
Will pelvic vein care service help reduce symptoms?
Overall, the treatment of pelvic veins with coil sealing and sclerotherapy can reduce a woman’s pelvic pain symptoms. Groin varicose veins and atypical leg varicose veins also respond well to this treatment.
Finally, for more information in an earlier blog we talk more about chronic pelvic pain.