Consultant general and vascular surgeon of Singapore’s MD Specialist Healthcare group and The Vein Clinic – Dr. John Tan – returns to answer your questions about vein problems.

Q: What types of vein problems do you treat? What can I expect during the first consultation with a vein specialist?
– Singapore

A: I treat all kinds of vein problems in any part of the body. These include spider veins, varicose veins, and also cosmetically ugly and prominent veins in the foot, hand or face area. I also treat problems that arise from vein disease or abnormal veins, such as leg ulcers.

During the first consultation, we usually perform a duplex ultrasound to assess the severity of the vein problem and then determine the vein disorder involved. Then we will discuss a suitable treatment plan.

Q: I've heard that new methods have replaced vein stripping or vein surgery. How do I know if the new methods are suitable to treat my problem?
– Penang

A: Vein stripping or vein surgery is a very invasive procedure. It requires anaesthesia, big incisions, two or three days of hospital stay, and there is also significant post-operative pain.

A new method called endovenous laser treatment (EVLT) is a better option for many patients. It is less invasive with no anaesthesia required, no incisions, less pain and a much faster recovery period. The chance of the problem recurring is also five to 10 times less likely.

In this procedure, a catheter is inserted into the whole length of the vein, and as it is drawn out, the laser heats and ablates the vein, thereby closing it. The vein then disappears as it is absorbed by surrounding tissue.

Q: Would closing veins using methods like endovenous lasers or EVLT cause problems with my leg as a result?
– Seremban

A: No. When the vein becomes varicose, it is no longer functional. The purpose of the healthy vein is to carry blood all the way back to the heart. Diseased or problematic veins may not perform this function due to leaky valves. This makes the veins a liability, and the patient’s circulation actually improves when the problem is treated.

In any case, there are enough good veins in the legs for circulation. There are five to seven big veins in the leg and hundreds of smaller ones.

Q: Is EVLT a widely performed procedure? Are the results permanent?
– Seremban

A: The use of endovenous lasers started in 2000 and since then, a few hundred thousand cases have been performed worldwide. The success rate is above 90 percent; I experience a success rate of about 99 to 100 percent with my patients. It also has no known major complications unlike vein surgery. It is safe and is not an experimental procedure.

And yes, it is permanent. The abnormal vein is closed up and disappears on its own. The procedure can take as little as 20 minutes to perform as well, unlike the one or two hours needed for vein stripping.

Q: My vein problems are unsightly but still minor. Is there a possibility of them developing into a more serious concern? Do you treat lighter vein problems for cosmetic reasons?
– Klang Valley

A: Yes, vein problems get progressively worse over the years, whether due to continued damage, disease or stress. Often, the valve inside the vein becomes defective resulting in engorged veins. As more damage accumulates, the bigger the vein expands, and this problem may spread to more and more veins. It could also lead to other complications such as deep vein thrombosis (formation of a blood clot in a deep vein), skin disease and profuse bleeding (see box).

Spider veins are smaller dilated blood vessels near the surface of the skin and are an example of a ‘lighter’ vein problem. I treat spider veins through injection sclerotherapy, where a foam solution is introduced, which causes the veins to collapse and fade away. Once again, the body absorbs the vein on its own.

Q: I’ve heard that lasers are good to treat small veins. Is this true?
– Melaka

A: That is true but only to a certain extent. In my experience, laser treatment alone is not as effective compared to sclerotherapy when treating spider veins. I use lasers to clear up very fine residue veins after an injection treatment, in fact. This is because the lasers that are used need to stay within the skin’s tolerance range, and therefore, are not very effective in treating veins, unlike injection sclerotherapy. However, there are cases where specialised lasers are useful (see box).

Q: I have dark skin and so my ‘problem’ veins are less of a cosmetic issue. But should I still be concerned about them?
– Kuala Lumpur

A: It is true that darker people will not be able to see their veins more clearly. But those who are more exposed in the sun could have more broken veins or varicose veins than they realise. A non-visual sign of varicose veins in the legs is achy or tired legs. Sometimes the calves cramp for little reason, or the ankles are swollen at the end of the day, or you could have skin problems in the area. There are a number of symptoms and you should seek medical help if you feel you have a problem.

Q: What happens after treatment and how long before I can resume normal activities?
– Singapore

A: Endovenous laser treatment is a day surgery procedure. Half an hour before the procedure, a scan is performed and the area to be treated is marked. Local anaesthesia is administered. The treatment time is usually between 20 to 45 minutes (depending on how much work needs to be done).

In most cases, whether treated for varicose or spider veins, the patient can get up and walk out of the clinic themselves. Activities can be resumed within a few days, but the extent of their performance depends on how the patient is feeling. Within one or two days, the patient will return for an aftercare consultation, though this is often optional.

Foreign patients who are on a tight schedule may not come back for consultation if there are no problems. There are no wounds, no stitches to remove, no post-operative care and no creams involved.

Q: What are the causes of vein problems and the cost of treatment?
– Kuala Lumpur

A: A big factor is inherited weakness or family history, which results in weaker veins. Veins could be weakened after prolonged stress, such as standing or sitting for a long time, crossing the legs, wearing high heels and pregnancy.
The cost depends on the type of treatment. Injection sclerotherapy for spider veins costs between S$500 (about RM1141) and S$2000 (about RM4564); endovenous laser treatment for varicose veins costs between S$4000 (about RM9124) and S$8000 (about RM18,248) and laser treatment for fine facial veins costs between S$500 (about RM1141) and S$1000 (about RM2281). Treatment is specific based on the patient’s condition.