VeinsClinicNZLtdDoc:01-02-2018

VARICOSE VEIN TREATMENTS

Varicose veins are easily treated by non-surgical methods. These simple vein procedures are performed by Dr Ian Little, a fellow of the Australasian College of Phlebology.

Endovenous laser ablation, Vnus Closure, VenaSeal or foam sclerotherapy are simple walk-in/walk-out office procedures. The safety and efficacy of these procedures to treat varicose veins are such that surgery for varicose veins is now nearly obsolete. The information here does not replace a full consultation, we are very happy to see you for a free initial assessment.

Just phone 0800 256 654 ask a question or for an appointment at clinic in your nearest area. We currently have clinics in Henderson- Auckland, Christchurch, Dunedin and Queenstown.

We offer free initial assessments; however there is a charge if you require a written report to be furnished for health insurance pre-approval of the treatment charges.

VARICOSEVEINSCLEROTHERAPY

Thisisatechniquethatinvolvesplacingamedicineintheunwantedveins,itisusedfortreatingvariousveinconditionssuchas;varicoseveins,reticularveins,spiderveinsoftheleg,andalsosomefinefacialveins.Varicoseandspiderveinsarepredominantinwomenandaffectupto40%ofthepopulation.

Notonlyarevaricoseveinsunsightly;sufferersenduresymptomssuchasaching,heavy,tiredlegs,throbbing,tingling,burningandcramps.Inthelatterstagesofthediseaseprocessskinchangescanleadtoarashandevenskin

VeinsClinicNZLtdDoc:01-02-2018

ulcers.Treatmentiseffectedbyinjectingamicro-foamintothevein,thismedicinereactswiththeinsideoftheveinandbodyreactsbyshuttingitdown.Thebloodflowdivertsbackintothedeeper,normalveinsandimprovesthecirculation.Theprocedureisvirtuallypainlessandthereforerequiresnoanaesthetic.Treatmentsofvaricoseveinsarefollowedbythewearingofcompressionhosieryforuptotwoweeks.

SclerotherapyhasbeenaspecialitytreatmentinEuropesincethe1960'sandwasalwaysthoughtasthetreatmentofchoiceforthesmallerspiderorthreadveins,whicharesocommononthefaceandlegs.Howevernowadays,withthehelpofultrasoundguidancetovisualisethelargerproblemveinsandwithadventoffoammedicine,eventhelargestofvaricoseveinsaretreatedsafelythisway.

Sclerotherapyisa30minute,virtuallypainlessprocedurewithhugeadvantagesoversurgery,includingnogeneralanaesthetics,nostitches,nohospitalisationandnotimeoffwork.Itisawalk-in,walk-outprocedurewithnotimeoffwork.

ENDOVENOUSABLATION

Usingultrasoundmaptoguide,thedoctorwillinsertacatheterintotheappropriatevein.Thenyouwillbeinjectedwithananaesthetictonumbtheleg,thisalsoemptiesbloodoutoftheveinandprotectssurroundingtissue.Energyintheformofradiofrequency(Vnusclosure®)orlaserlight(EVLT)createsaheatideallyof85degreesemittedfromthecathetertoheattheveinwall.Thiscausesittoshrinkandclose,redirectingbloodtohealthierveins.Thisproceduretakesaround1hour.

Thistechniqueisonlysuitableforstraightsegmentsofthevaricoseveinandforveinsmeasuringover0.35cmindiameter.

VeinsClinicNZLtdDoc:01-02-2018

WeareaSouthernCrossAffiliatedprovider,wealsodoworkwithallthelargerhealthinsurancecompanies:NIB,Unimed,AccuroandSovereignincluded.Medicalcriteriaapplypriortofundingfromhealthinsurersandnopaymentisgivenfromhealthinsurerspurelyforcosmeticimprovementofyourlegs.

Foryourvaricoseveinstreatmentexpenses,wecanofferinterest-freefinanceover12to24monthstoQ-cardholders.Pleaseaskourreceptionifthisisanoptionyouwouldliketoexplore.

VeinsClinicNZLtdDoc:01-02-2018

VARICOSEVEINTREATMENTS-AGUIDE

Whatarevaricoseveins?

Dilatedbloodvesselscanappearonanysurfaceofthebodybutareparticularlycommononthelegs.Varicoseveinsareusuallydefinedasthelargerveinsthatreallybulgeabovetheskinsurface.Badvaricoseveinsareoftenfoundinassociationwithareversebloodflowproblem–aleakyvalveinsidetheveinmakingtheveinsundertheskinblowupfromthebackpressureofthedeeperveins.

WhyhaveIdevelopedabnormalveins?

Thetruecauseishardtodeterminebutthedevelopmentofvaricoseveinshasperhapsmanydifferentfactors.Thesinglemostimportantthingisaninbornpredisposition.Otherfactorsmaybelongperiodsofstanding,diet,obesityandsmoking.Varicoseveinsseemtodevelopslowlyandprogressivelyasadegenerativediseaseofthewallofthevein.Asthediseaseprogressesthevalvesintheveinsbecomefaultyleadingtoincreaseinpressuretothesurfaceveinwhichthenenlarges.Itisimportantduringtreatmentthatthefaultyvalvesareidentifiedforspecifictreatment.Around25%ofpeoplewillhavevaricoseveinsandmoresoasweagesoinfact50%ofpeopleover50yearshavesomedegreeofvaricoseveins.Varicoseveinsoccurinbothmenandwomenbutmorefrequentlyinwomen.Thefemalehormonesmayplayaroleintheirdevelopmentandcertainlypubertyandpregnancyseemtobringthemon.

CanVeinProblemsBePrevented?

Wearingspecializedvenoussupportstockingsmaypreventsomedilatedbloodvesselsfromdevelopinginsomepeople.Thismaybeimportantduringpregnancy.Agooddiet-richinantioxidants,maintaininganormalweight,regularexercise,avoidingconstipation,heavyliftingavoidingwearinghigh-heeledshoesmayalsobehelpful.

VeinsClinicNZLtdDoc:01-02-2018

WhatsymptomscanIattributetomyvaricoseveins?

Symptomsincludeheaviness,aching,burning,stinging,throbbing,swellingandlegcrampsandlegrestlessness.Thepresenceofanitchyskinrashontheleg,smallblueveinsonthefeet,lowerlegskindiscoloration,pigmentationandscarringareoftenduetolargerveinshigherupintheleg,sometimeshiddenfromview.Ifuntreatedvaricoseveinstheycanpredisposetolegulcersanddeepveinthrombosis

DoIneedtreatment?

Abnormaldilatedvaricoseveinsdocarrybloodbuttheyarenotveryefficientandareoftennotnecessarytothecirculatorysystem,badlyfunctioningvaricoseveinsarebetterremoved.Thebodywillhavealreadyestablishedalternativeroutesforthebloodtotravelbackmoreefficientlytotheheart;treatmentactuallyimprovesthevenouscirculation.Manypeoplewishtohavetheirveinstreatedtoalleviatetheirsymptomsdescribedabove,butalsotheyfindthemugly,theirselfimageisharmedandthislimitstheirlifestylechoicesinexposingtheirlegsduringsportsactivitiesorindeedfashionchoices.Manyclientsreportanincreaseinselfesteemandanabilitytowearshortsorgoswimminghavingcompletedtreatment–largechangeswhichwillbenefittheirlifestyle.Preventionofpossibledeepveinthrombosisandpreventionandthetreatmentoflegulcersarealsoworthyreasonsforhavingtreatment.

WhatisthebestwayIcantreatmyvaricosevein?

Removaloftheveinscanbedoneby:

Injectionsoffoamsclerosant. LaserorRadiofrequencycauterytreatmentfrominsidethevein Venaseal-anewpatentedwayofgluinglargeveinsclosed

VeinsClinicNZLtdDoc:01-02-2018

HistoricallytreatmentwasbysurgicalremovalhoweverthenewtechniquessuchasofferedbyDr.Littlehaveadvantagessuchthatsurgeryforvaricoseveinsshouldnowbeobsolete.

Foamsclerotherapyinvolvestheinjectionofasolutionorfoamintotheunwantedabnormalvein.Thefoamisspecificallymanufacturedforveinsclerotherapy.Itisrapidlydilutedaftercontactwiththevaricoseveinwallandsodoesnotcauseanyharmasitcirculatesthroughthebodyandiseventuallywashedout.Themedicineirritatestheliningoftheveinscausingittoswellandstickclosed,theveinsfadefromviewoverperiodsofweeks.

Liquidsclerotherapyhasbeenperformedsincethe1930’s.Itcanbeusedforsurfaceveinsbydirectinjectionorfordeeperveinsbyinjectingunderguidanceofanultrasoundpicture.

Advancesinultrasonicimagingtechnologyhavesignificantlyenhancedtheaccuracyandsuccessinthetreatmentofthelargestofvaricoseveins.

Priortotheprocedure,anultrasoundscanofyourlegsisperformed;thisexaminationiscalledamappingscan.Thiswillfamiliarizethedoctorwithyourspecificveinproblemandclarifyanydifficultareasifnecessary.Followingtheprocedureyouarerequiredtowalkimmediatelyandwillwearagraduatedvenouscompressionstockingfor2weeks.Don’tworrytheycanbequitecomfortableandcancomeinblackcoloralso.Youmustwalkforatleast30minutesoneachdaythatthestockingison.Itisessentialthatyouwalkfor30minutesimmediatelyaftertheprocedureanditisgoodideatowalkfor30minutesseveraltimesperdayforthefirst3daysfollowingtreatmentorwheneverthelegaches,youmustnotdriveyourcarafteratreatmentuntilyouhavecompletedyour30minwalk.

Itisusualfortheretobesometenderness,lumpiness,hardnessandbruising/discolorationalongthelineofthetreatedvein,Iftherearespecifichardlumpsclosetotheskinsurfaceitmaybenecessarytohavethesereleasedbythenurse.Thisisusuallydoneinthefirst6weeks.Anydeeperlumpsthatstillremainwilldissolveovertime.

EndovenousLaserAblationisanewermethodoftreatingmajorveins.Itishighlysuccessfulforthelargerstraightveins,nowthoughttobethegoldstandardfortreatmentoflargerveintrunks.Thistechniqueisalsoperformedunderultrasoundguidance;itdoesrequiresomelocalanesthetic.Bythreadingatinyfibrewiththeaidofultrasoundimageguidanceintotheunwantedveinanddirectinglaserenergydirectlydowntheunwantedvein,itcanbedestroyed.Althoughitismoreinvolved,thistechniquehasadvantagesofefficiencywithasingletreatmentwhentreatinglonglargestraightveins.Itcanbeperformedonitsownbutforbestresultsitisoftenwithsclerotherapyonthemoretortuousveinslowerinthelegs.Lasertreatmentssuchasthesehavebeendevelopedbyphlebologistsandhavegainedpopularityduetoitssimplicityandmoreeffectivenesswithonesingletreatmentsession.

VeinsClinicNZLtdDoc:01-02-2018

RadiofrequencyEndovenousAblationisaverysimilartechniqueasthelasertreatment,justdeliveringnotalaserbutradiofrequencyenergytotheveinswallbyasmallguidewire.Ithasreportedsimilarsuccess.

WillIneedongoingtreatment?

Theveinstreatedadequatelybysclerotherapywillnotrecur.However,theunderlyingconditionwillpersistandthereforenewvesselsoftenparalleltotreatedveinsmayappearwithtime.

Thetreatmentsareguaranteedtoclosethelargeveinsandcheckscansandfurthertreatmentssessionsareofferedaspartoftheinitialcostoftreatment.Butthinkofyourtreatmentasaprocessofmorethanjustonevisit.Yourfirstreviewappointmentwillusuallybeat2-3weekstocheckyourprogress.Afurtherreviewappointment,includingascanisbestmadeafter3months.Ifyouhavemorethanonedeepveinthatneedstreatment,orverylargeveins,youaremorelikelytoneedafollow-uptreatmentbysclerotherapy.Thelaserendovenousablationtreatmentisverysuccessfulwithonlyonetreatmentevenonthelargestofveins.Subsequenttreatment,ifnecessary,isusuallypreformedatthethreemonthsfollowupvisit.Oncethedoctorfeelsthetreatmentiscompletethenafurtherscan6monthslaterisrecommendedtoensurecompletedtreatmenthasbeenachieved.Yourinitialfeeswillincludethecostoffollowupscanandupto3treatmentsifrequiredforclosureofthelargeveins.Howeverbewarnedthatyourinnatetendencytodevelopvaricoseveinsisnottreatedasthisstayswithyou:newveinsmayopenupeventuallynecessitatingfurthertreatmentyearslater.A5yearlycheckupisrecommendedtodetectthedevelopmentofnewveins.

Whatcangowrong?

Likeanyproceduretherearesomeriskssopleasebewareoftherisks.Itisimportantthatyouexpectsomeeffectsofthetreatment,pleasereadthisandexpressanyparticularworriesyouhavepriortoanytreatment,wecanexplainyourownrisksfurther:

VeinsClinicNZLtdDoc:01-02-2018

*Bruisesatinjectionsites.Thesewilldisappearinafewweeksandareprobablyrelatedtothefragilityofbloodwalls.Bloodtrappedinthetreatmentveinsmayresultintheveinbecomingmorenoticeableinthefirstfewweeksfollowingtreatment.Thisisanearlysignthatthetreatmenthasbeensuccessful.

*Achinginthelegforthefirstfewdaysaftertreatment.Itisusuallyrelievedbywalking.YoumayalsotakePanadoltorelievethisaching.

*Phlebitis:Thisisinflammationofthetreatedveins,whichmayalsobeassociatedwithtenderlumpsalongthelineofthetreatedveins.Theselumpsarenormalandareduetothereactionofthesclerosantonthebloodvesselwallandthetrappingofoldblood.Whenitoccurstoalargeorprolongedextent,itmaybetreatedbydrainingthebloodoutbysmallneedlepunctures.Othertreatmentsforthismayincludedanti-inflammatorymedications,heatpacks,massagewithandanti-inflammatorycream,compressionstockingandregularwalking.Thelumpswillalwaysdisappearwithtime.

*Pigmentation:Thisistheappearanceofbrownmarksontheskinaftertreatmentcorrespondingtowheretheveinsweretreated.Itisconsideredtobeanormalconsequenceofhavingvaricoseveinstreated.Somestudiesshowinganincidenceashighas16%at6monthsand5%at2years.Thesepigmentedareasaremainlycomposedofhaemosiderin(aformofironstoredintheblood)andresultwhenbloodescapesfromtreatedvein.Pigmentationismorelikelytooccurinpatientswhohavelargerveinstreatedorthosepatientswhohavehadalotofbruising.Inmostcasestheydisappearcompletelywithinayear.

*Matting:Thisisthedevelopmentofnetworksoffineredbloodvesselsnearthesitesoftheinjectionandismorelikelyonthethighs.Mostresolvewithinjectiontreatmentandafewpersist.Mattingismorecommoninpatientswithextensivesurfaceveins,deepveinproblems,patientswhohaveafamilyhistoryofsurfaceveinsandinobesepatientswhohavepoormuscletone.

*Ulcers:Veryoccasionallythereistheformationofsmallulcersattreatmentsiteswithin2weeksofinjection.Thesemayoccurbecausethesolutionhasescapedintoanabnormalconnectionbetweenthesmallveinsthatareinjectedandthenearbyarteries,orbyinadvertentinjectionofdirectlyintosmallarterioles.Ulcersaremorecommoninpatientswhosmokecigarettes.Theyhealslowlyandmayleavesmallpalescar.Iftheulcerbecomesinfectedanantibioticisprescribed.

*AllergicReactions:Althoughonrareoccasions(1per5,000treatments)suchreactionsmaybeserious,theycanbetreatedbyimmediateinjectionsofadrenaline.

VeinsClinicNZLtdDoc:01-02-2018

Lessseriousreactionsaretreatedwithantihistamines.Minorrashesrequirenospecifictreatmentbutyoushouldinformyourphlebologistiftheyoccur.

*DeepVeinThrombosis(clotinadeepvein)thiscanoccurbutisuncommonifcompressionandregulardailywalkingareadheredto.Symptomswouldbepain,causingalimponwalking,tenderswollenleg.Shouldathrombusbreakofffromthelegveinsitcantraveltotheheartandlungsandcausesharpchestpainormakeyoubreathless.

*Intra-ArterialInjection.Thisisanextremelyuncommoncomplication,inadvertentblockageofanarterymayresultinmuscleandskindamage.

*Paraesthesia.Asmanyoftheveinswetreatareclosetonervesinthelowerlimb,thenervesmaybedamagedbythelaserbeamorsimplyirritatedbytheinjectionprocessorfromtheinflammationthatensuesfollowingasclerosantinjection.Thisusuallytakestheformofnumbnessandmaylastseveralmonthsbeforefinallyresolvingcompletelywithoutanytreatmentrequired.

*VisualDisturbance(VisualScotoma)canoccurduringorimmediatelyaftersclerotherapyandmaybeassociatedwithheadache.Itsettleswithsimpleanalgesiaandisprobablymorecommoninpeoplewhosufferfrommigraine,orpeoplewithco-existingheartproblems.

Therearenoknownlongtermsideeffectsofthesclerotherapypharmacologicalagents,theproductsdonotstayinyourbody,theyallbiodegradablewithahalf-lifeinyoursystemofonlyafewhours.

Howmuchdoesitcost?

Weofferfreeassessmentssothatwecanaccuratelyquoteyouforyourtreatment.Sclerotherapyandendovenousablationtreatmentsofvaricoseveinsismuchmorecosteffectivethanthesurgeryperformedinthepast,costswillbequotedatthetimeofyourinitialassessmentandconsultation.Ourcostusuallycoversforacompletecourseoftreatmentstocapyourbudgetfromanyhiddenextrastoensuretheprocedurehas

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beenthrough.TherearepaymentplansavailableforvaricoseveintreatmentsthroughQ-Card.

Threadveintreatmentscancomefrom$485.00persession.

WillmyInsuranceCompanypayforvaricoseveinremoval?

Pleasecheckyourpolicyfordetails,manysurgery-onlypolicieswillcoverforthesetreatments.Priorapprovalshouldbesoughtfromyourhealthcareproviderbeforeembarkingontreatment,wecanhelpyoubypreparingareportonyourcondition.Bearinmindthatcosmeticenhancementsarenotprovidedfromhealthinsurersandforhealthimprovementtherehastobeaveinproblemthatcandemonstratesomedegreeofmedicalnecessityforitsremoval.Discussthiswithyourfamilydoctororthephlebologistattimeoftheinitialconsultation.DrLittleisarecognizedoranaffiliatedproviderforallthemajorinsurancecompanies.

Thesmallerthreadveinsareoftenofonlycosmeticconcern,thereislittlemedicalnecessitytoremovethemandtreatmentofthreadveinsisnotcoveredbyinsurancecompanies.Askatthetimeofconsultationaboutanyongoingcoststoremoveanyremainingthreadveinsfollowingvaricoseveintreatment.

WheredoIgofromhere?

Thisinformationisprovidedforyourperusalbutnotreplaceafullconsultationwithanexperiencedphlebologist.Werecommendyoumakeanappointmentsoeverythingcanbeexplainedtoyoursatisfactionpriortoanydecisiontohavetreatment.

Phone0800256654andaskforanassessmentatacentrenearestyou.

VeinsClinicNZLtdDoc:01-02-2018

MICRO-SCLEROTHERAPYTREATMENTOFTHREADVEINS

Manypeople,becauseoftheirgeneticmakeup,willdevelopsmallthreadveinsintheirlegs.Theseareunsightlyandinmanycasescanache.Althoughtheproblemisinherited,thingssuchasobesity,varicoseveins,prolongedstandingandpregnancycanworsentheproblem.Threadveinsontheinsideofthelegsmaybeanindicationofhiddendeepervaricoseveins.Allclientswithveinsontheinsideoftheirlegsshouldbeassessedforpossiblevaricoseveinseventhoughtheyarenoteasilyvisible.Insurancecompanieswillseethehealthbenefitsoftreatinglargevaricoseveinsbutwillnotfundmicro-sclerotherapyofcosmeticallyembarrassingthreadveins.Ifyouarehavingyourvaricoseveintreatmentfundedbyyourhealthinsurerthenbewarethatyouwillincuranextrachargeformicro-sclerotherapytoachievebestcosmeticresults.Usingaveryfineneedle,asclerosant(mostlysaltwater)isinjectedintotheveinswhichcausetheveinwallstobecomesticky.Initiallythetreatedareaswillbedarkerandmayappearbruised,then,astheyhealoverthenext2-3months,theywilldisappear.Inmostcase3treatmentsaresuggesteddependingontheseverityoftheproblem.Afterthethirdtreatmentmostpatientsfeeltheyhaveachievedaroundan80%improvement.“Thistreatmentis100%successfulingettingatleastan80%improvement-aslongasthepatientiswillingtoattendforrepeattreatments.”Compressionstockingsarerecommendedfollowingtreatmentforoneweek.Ifyouhavelargerorvaricoseveinsinthesurroundingareaitisadvisabletotreatthosefirst.Thiswillincreasethesuccessrateofthreadveintreatment.DOESITHURT?Treatmentisrelativelypainless;mostpeopledescribeitasuncomfortableratherthanpainful.HOWLONGDOESTHEEFFECTLAST?Mostpeoplerequiredre-treatmenteveryfewyears,someelecttohavesmallareasdoneonceeverywinter.Obviouslypregnancycanmakemattersworse,ascancertainjobs,etc.HOWSAFEISIT?Thetreatmentisextremelysafeandnomajormedicalproblemshaveoccurredinmyexperience.Patientsareaskedtoconsiderrarecomplicationsrecognisedforsclerotherapyaslistedonourconsentform.WHATSIDEEFFECTSARETHERE?

VeinsClinicNZLtdDoc:01-02-2018

Occasionally(usuallyinoliveskinnedorsuntannedpeople)darkpatchesofpigmentoccurovertreatedareas.Occasionallyclientswillnoticesmallerveinsappearingaroundthetreatedarea.Thisismorecommoninclientswithhiddendeeperveins,womentakinghormonesupplementsandmayoccurinaroundoneinfiveofthesepatients.Itisoftenresolvesspontaneouslybutcanalsobetreated.Onextremelyrareoccasionsasmallulcermaydevelopoveratreatedveinwhichhealswithin1-2weeksbutmayleaveasmallscar.Allowuptoanhourfortreatmentsessioninourrooms,thereafteryouarerequiredtogoforawalk.ThetreatmentcanbeperformedbyoneofDrLittle’snurses.Cost$265forverysmallareas$485persessionofmicro-sclerotherapy $895persessionofComplexSclerotherapy:toincludelongpulseNdYagLaser(ClaCs)orforUltrasoundguidedinjectionsintofeedingvesselsinclientswithunderlyingveins.NumberisANZ010798-0482458-00(VeinsClinicNZLtd