Varicose Veins Treatment

Understanding the nuances in practice across Melbourne and Australia for the treatment of varicose veins.

The costs of treatment vary quite considerably based on the severity of your venous disease, what procedure is required, whether you have open surgery or minimally invasive treatment, as well as whether or not you have private health insurance, level of coverage and whether you opt for public or private treatment.

How do I know what treatment is required?

Today, most patients are offered minimally invasive treatment for their varicose veins. Treatment generally involves ablation of the main insufficient/refluxing vein with heat (laser or radiofrequency ablation) or venaseal (medical grade glue) and their branches (surface or spider veins) with sclerotherapy. Without an ultrasound performed by an experienced vascular sonographer and assessment by a vascular specialist, it is impossible to know what treatment is required. However, most of our patients are recommended endothermal ablation with sclerotherapy as a primary treatment. In a smaller subset of patients they may be offered sclerotherapy only, however this is less common. Finally some patients are sometimes offered traditional open surgery. Our pathway of recommendations follows that of the National Institute for Health and Care Excellence (NICE) Guidelines (UK).

1.3 Assessment and treatment in a vascular service

Assessment

1.3.1

Use duplex ultrasound to confirm the diagnosis of varicose veins and the extent of truncal reflux, and to plan treatment for people with suspected primary or recurrent varicose veins.

Interventional treatment

1.3.2

For people with confirmed varicose veins and truncal reflux:

Offer endothermal ablation (see NICE’s interventional procedures guidance on radiofrequency ablation of varicose veins and endovenous laser treatment of the long saphenous vein).
If endothermal ablation is unsuitable, offer ultrasound‑guided foam sclerotherapy (see NICE’s interventional procedures guidance on ultrasound-guided foam sclerotherapy for varicose veins).
If ultrasound‑guided foam sclerotherapy is unsuitable, offer surgery.

If incompetent varicose tributaries are to be treated, consider treating them at the same time.

Private treatment

Treatment in the private sector comes in many shapes and sizes. Generally this involves treatment in a practitioners rooms or in a private hospital. Patients with gold or silver level private cover are generally covered for treatment in hospital. However, this treatment can only be carried out by a vascular surgeon (denoted by the qualifications FRACS – Fellow of the Royal Australian College of Surgeons). Some surgeons will still charge a “Gap” payment. This is an additional amount on top of your hospital excess.

Therefore for patients who are covered with their private health insurance, cost = hospital excess as per insurance policy + surgeons fee + anaesthetist cost + post operative compression stocking + sonographer fee (if charged). The gap for a surgeon can ranges generally from $0 to a few thousand dollars. We are a “no gap” provider for many health funds.The anaesthetist cost is usually around $350-500. Note however, these costs are an estimate only and a detailed assessment with informed financial consent is required prior to proceeding with surgery.

In room treatment is becoming a more common option with modern minimally invasive techniques. These allow patients to have “walk in/walk out” same day treatment without the need for general anaesthesia, sedation or admission to hospital. This allows patients without private health insurance, or venous disease not severe enough to require public hospital treatment to have their veins treated. It also allows greater flexibility to when the procedure can be performed. However, the costs of consumables, staffing, rent, dressings and stockings need to be covered by the patient. Medicare sometimes will provide a rebate of around $500 for approved indications. The costs for this vary greatly between practioners, but range from $2000-$6000 per leg treated or $3500-$12000 for two legs. Please contact the practice to obtain current costings.

Sclerotherapy

Sclerotherapy is a non surgical treatment for varicose veins. Sclerotherapy is used to injury the veins and cause them to become irritated and stick together. This leads to damage of the veins, but in doing so causes them to scar and shrink. The veins eventually disappear altogether.

Is the cost of sclerotherapy the same?

Generally no, sclerotherapy is cheaper. It is used to treat surface and spider veins, but it is not as effective as treating patients with larger veins with more significant reflux. Again, costs vary from practitioner to practitioner but can range anywhere from $400- $2000 per leg.

Public funding for treatment of varicose veins.

Any patient with a medicare card can be referred to the public health care system to be seen for consideration of treatment of their varicose veins. Unfortunately, the public sector cannot sustain treatment of every single patient with varicose veins- otherwise it would be overwhelmed. Consequently, the public health sector is designed to primarily treat people with complications from their varicose veins. This means patients with visible leg swelling or worse (venous ulcers). The Victorian governments stance on the public treatment of varicose veins can be found on the Department of Health Website (https://src.health.vic.gov.au/varicose-veins). Generally, the Victorian Government is happy to fund in hospital treatment for patients who have C3 disease or greater.

The wait times vary quite significantly again. Some hospitals which have embraced minimally invasive treatment and as such have significantly reduced their wait times for assessment and surgery. Another factor to consider is that some hospitals are still recovering from the extended wait times for surgery as a result of the COVID pandemic.