Varicose vein treatment options

A new treatment for varicose veins looks promising but there’s a danger unqualified operators could benefit at the expense of patients.
 
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03.Procedures, risks and costs

Procedures

Microsclerotherapy and ultrasound-guided sclerotherapy

An irritating liquid or foam is injected into the blood vessel, causing it to swell and stick together, aided by external pressure from compression stockings. The blood vessel is eventually absorbed by surrounding tissue and fades from view. This treatment is often used in conjunction with vascular ultrasound to guide the injections in larger and/or deeper veins.

Costs: This ultrasound-guided sclerotherapy costs about $800-$1000, with a $300 Medicare rebate; sclerotherapy for small veins and spider veins is more like $300-$500, with a $100 rebate.

Ambulatory phlebectomy

A tiny incision is made over the vein which, using a phlebectomy hook, is pulled out until it breaks or cannot be pulled any further. The process is repeated along the entire length of the vein to be extracted, and no stitches are necessary.

Costs: It costs about $900, with a $300 rebate.

Endovenous laser therapy

The vein is punctured near the knee or ankle, depending on which part of the vein is being treated, and a fine laser probe inserted. The laser is activated, causing the vein walls to fibrose and close off as it’s withdrawn. The procedure involves minimal discomfort and local anaesthetic is used to reduce pain.

Costs: A Medicare rebate of about $600 is in the pipeline, but for now you’re looking at costs of between $3000 and $4000 per treatment. See below for more about endovenous laser therapy.

Radiofrequency ablation

Similar in technique and outcome to endovenous laser therapy, radiofrequency ablation uses a catheter to heat the blood and destroy the vein.

Costs: Costs and risks are similar to endovenous laser therapy, but there’s no Medicare rebate available.

Surgery

An incision is made at the top of the leg over the vein, which is then cut and tied off (ligation). A thin wire is inserted down the length of the vein and the vein pulled out – stripping. Smaller incisions may be needed to separate connecting veins along the way.

Costs: It costs about $2000 plus hospital and anaesthetic costs. The Medicare rebate is about $500-1000, but check with your doctor for a better estimate.

Treatment risks

All types of treatment are likely to result in temporary bruising, aching, discolouration and inflammation. Deep vein thrombosis (DVT) and temporary numbness due to nerve damage are rare. For one treatment, sclerotherapy, additional but rare risks include pockets of blood trapped in veins (this is different from DVT), pigmentation along treated veins, allergic reaction to the solution and skin ulceration.

Costs and rebates

Medicare rebates apply to most procedures considered medically necessary, so your varicose vein treatment needs to be more than just a cosmetic concern, and veins should be 2.5mm or more in diameter and have reflux. The cost and rebate figures we’ve provided are only a guide for comparative purposes, and your doctor will be able to give you a more accurate guide to out-of-pocket expenses.

Private health insurers don’t cover most treatments because it doesn’t take place in a hospital, however they may cover part of the cost of post-operative compression stockings.

 

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