The practice of open vein surgery in hospital, performed under general anaesthetic and usually including deep groin dissection, was abandoned in our service 10 years ago, as it has in most modern phlebology practices in the Western World. It has been replaced with ambulatory outpatient treatment, comprising endovenous laser ablation of incompetent main-stem veins, ultra-sound guided sclerotherapy, microphlebectomies, and visual microsclerotherapy.
This is in line with the National Institute of Health and Care Excellence (NICE) guidelines; published in July 2013; which recommend ambulatory treatment of lower limb vein disease by laser therapy ahead of any consideration for open surgery.
Treatments at our Laser Vein Clinic are all performed under local anaesthetic, with ultrasound guidance. This provides patients with walk-in walk-out therapy, less perioperative discomfort, less invasive and inherently safer therapy, and early return to normal activity. Each procedure attracts a generous Medicare rebate when patients have reached the extended Medicare safety net threshold; making it affordable for most. Private health insurance cover is not necessary.
Over the past 10 years we have treated over 3980 veins with varicose veins by endovenous laser ablation, achieving primary closure rates of >99% and durable outcomes on medium term ultrasound follow-up. Our evaluation of this treatment is ongoing, but it’s found wide acceptance in the community of patients wanting treatment out of hospital, with no groin scar, and little disruption to their work / life balance. As past Vice President of The Australasian College of Phlebology, I’ve been pleased to be involved in shaping the future of vein treatment in this country, and to ensure we are kept up to date with what the best practices have on offer.