Varicose veins are prominent, swollen, tortuous and enlarged veins, mainly found in your legs. They can ache, feel heavy and be uncomfortable. They may bother you for aesthetic reasons. There are many treatments available for varicose veins – from minimally invasive procedures such as laser endovenous ablation and glue ablation to open surgery.

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Why do I have varicose veins?

Before we dive into the treatment options for varicose veins, let’s explain first what they are and why you may get them.

What are varicose veins?

Varicose veins are swollen, tortuous and enlarged veins that often appear on the legs and bother people because of their appearance.

In some cases, however, varicose veins can cause:

  • Aching, heavy and uncomfortable legs
  • Swollen feet and ankles
  • Muscle cramps in your legs
  • Dry skin, colour changes and eczema in the legs
  • Ulcers

Why do I have them?

The veins of your leg allow the blood to be transported from your feet to your heart. Valves within the vein allow the blood to flow in one direction. 

When you have varicose veins it means those valves are not properly working and the blood can flow backwards. In other words, the blood is collected in the vein, eventually causing it to be swollen and enlarged, resulting in varicose veins.

Dr Nishath Altaf Vascular surgeon Perth
Dr Nishath Altaf

Varicose vein specialist Perth

The likelihood of this happening depends on many factors, and age is only one of them. 

The top 5 reasons why you may have varicose veins


Damaged vein valves are the primary cause of varicose veins. When we age, these valves naturally weaken. Consequently, as the valves lose their elasticity and strength, the risk of varicose veins increases. 

But even before you reach the age of 40, you may see raised ropes of blue and purple veins on your legs and feet. That’s because there are other factors that can cause varicose veins.


About 2 in 5 pregnant women develop varicose veins due to hormonal changes. As the growing foetus requires more blood volume, there is more pressure in the pelvis and in the legs. The progesterone hormone also widens and relaxes the veins. This in turn can cause varicose veins. In most cases, these varicose veins will disappear after child delivery. 


Varicose veins tend to run in families. So if some of your close family members suffer from varicose veins, you are likely to get them too, eventually. 

Hormone therapy

Birth control pills containing oestrogen, one of the main female sex hormones, may increase your risk of developing varicose veins. Hormone replacement medications prescribed to lessen the symptoms of menopause may also increase your risk. 


Extra weight adds to the stress put on the veins in your legs and abdomen. A regular exercise routine that focuses specifically on building up calf muscles — such as walking and biking — helps support the veins as they pump blood back to your heart. 

If you spend many hours during the day sitting at a desk, be sure to get your blood flowing again by taking frequent short walks and flexing your ankles while seated.

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Types of varicose vein treatment

There are many treatments available for varicose veins. Some are minimally invasive, such as laser endovenous ablation and glue ablation. In other cases, your vascular surgeon will do open surgery.

The type of treatment depends on the size, extent, location and dimensions of the venous damage.

To assess this, we perform an ultrasound that maps out all varicose veins. Then I will clinically assess your veins and discuss the different options available to you. 

Dr Nishath Altaf Vascular surgeon Perth
Dr Nishath Altaf

Varicose vein specialist Perth
Vascular Surgeon Perth
Adjunct Clinical Associate Professor at Curtin University

Even though some treatments have better outcomes than others, some people prefer a procedure that is covered by private health funds. For varicose vein treatment, there is only one procedure covered by private health insurance, and that is open surgery. Let’s go over all your options. 

Open surgery - stripping of varicose veins

Open varicose vein operations are usually performed as day case procedures in hospitals. The vast majority of patients can be treated very successfully with minimally invasive surgery, however in a small proportion of patients open surgery may be indicated. 

The exact type of operation depends upon the anatomy of the varicose veins and may include stripping of the varicose veins or avulsions.
An incision is generally performed in the groin, and the vein that is not working is tied off. This vein is then removed from the leg through another small incision further down the thigh or leg. Smaller incisions are made over the varicose veins and are removed. The groin is closed with dissolvable stitches and the leg is wrapped in compression bandaging.

Good results but not as good as other minimally invasive procedures.

80-85% of patients will not get varicose veins back after 10 years.

2 weeks recovery

Private health:
Covered if appropriate health cover

Endovenous laser ablation

What is it:

A tiny puncture is made in the leg. It does not require stitching and only local anaesthesia is needed. Laser energy is then used to heat damaged veins and seal them closed. A laser fibre is used to shut the varicose vein from the inside without the need for a scalpel.

This fibre is inserted through a small cut in the skin around the knee or ankle into the varicose vein.

It is guided into place by ultrasound. Local anaesthesia is then used to and the laser is then fired, which delivers laser energy to the vein wall. Inflammation of the vein wall then occurs over weeks or months, resulting in fibrosis which then closes off the vein.

There is a very high success rate associated with this procedure, with more than 95% of patients reporting improved symptoms.

Before medical advances, the best treatment choice for varicose veins was thought to be ligation and stripping (open surgery). However, minimally invasive endovenous laser ablation has now become the treatment of choice for vascular specialists. It is a first-line recommendation by the European Society of Vascular Surgeons as well as the US vascular societies in the treatment of varicose veins. Most varicose veins can be treated like this.

Excellent results

95% of patients will not get varicose veins back after 10 years.

Minimal, it’s an outpatient procedure done in my rooms. Most patients can resume regular activities the following day, but ideally should not restart heavy exercise for at least a week.

Most patients usually go back to work within a couple of days, however if your job involves significant leg activity or prolonged standing, then it is suggested to take some more time off prior to starting work.

Private health:
Not covered (but eligible for a medicare rebate)

Venaseal glue ablation

What is it:

This treatment allows the application of specially formulated glue to close the vein. When the VenaSeal or the superglue treatment is performed, only one needle is needed per vein treated. There is no need for additional local anaesthetic injections around the vein – unlike endovenous laser ablation.

Venaseal works by delivering medical glue directly in the affected vein using ultrasound. Pressure is then applied to close the vein with the glue. The blood is re-routed to healthy veins.

Very good results

85-90% of patients will not get varicose veins back after 5 years. As it is a newer treatment, long-term results are unknown.

Minimal, it’s an outpatient procedure done in my rooms, with no requirement for stockings. – similar to laser recovery

Private health:
Not covered, but eligible for a medicare rebate


What is it:

Ultrasound-guided foam sclerotherapy involves injecting a solution – a chemical agent known as a sclerosant – to eliminate varicose veins through blood vessel scarring and closure. Sclerotherapy has been used in medicine for more than 150 years.

Medical advances have seen the comeback of sclerotherapy due to the more frequent introduction of duplex ultrasound and foam sclerosants. It is an effective and simple treatment for varicose veins.

With foam sclerotherapy, the liquid sclerosant is mixed with air to create foam. Under ultrasound guidance, it is injected into the varicose vein, displacing the blood within the vein, and filling it with the sclerosant. As a result, the vein spasms and scars. The vein is then checked with an ultrasound to measure the success of the injection.

Ultrasound-guided sclerotherapy improves the accuracy, safety and efficiency when treating large varicose veins. Veins can be accurately mapped with the help of ultrasound which helps direct the needle tip to the targeted vein. The sclerosant is then injected into the vein through ongoing monitoring, which also helps Dr Altaf control the injection’s direction.

This treatment allows the closure of smaller veins and spider veins - It does not work as well in bigger veins where the failure rates tend to be higher.
It is also used as an adjunct to treat smaller veins after the larger veins have been treated with laser or glue therapy.


About 60% of patients will not get varicose veins back after 3 years. Veins may need to be re-injected to improve the success rate. Early recurrence is monitored through regular ultrasound surveillance.

Patients usually walk out after the procedure and resume normal activity the following day. Usually patients are expected to wear stockings for 1 week.

Private health:
Not covered

Frequently asked questions

Vascular surgeon Perth Dr Altaf - About Dr Nishath

Dr Altaf

As a vascular surgeon, I believe there is no one size fits all. This means appointments take as long until you fully understand the condition and are happy with my approach to get you the best treatment option. 

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