Podcast: Dr Nicola discusses the treatment of Varicose Veins and Endovenous ablation

Listen to Dr Nicola discussing the treatment of Varicose Veins


So I’d like to welcome to the Pod M.D. studio Dr. George Nicola today.
George is a procedural phlebologist and director of Bondi Vein Clinic in Bondi Junction triaging and providing treatment for Varicose Veins, spider veins and reporting on venous conditions using the latest ultrasound technology.
In today’s podcast we’ll be discussing the latest development and techniques for the treatment of Varicose Veins. So George thanks so much for coming into the Pod M.D. studio today.

Thanks for having me Sean.

Well the topic today is Varicose Veins and in particular what is new in treating Varicose Veins. Would you like to answer that for our listeners George.

Yes definitely. The newer techniques for treating Varicose Veins are collectively called Endovenous ablation which means ablating the vein from within as opposed to the traditional surgical approach which usually is referred to as high ligation stripping which means removing the vein and ligating the end of it.

So how effective a treatment is Endovenous ablation?

Studies show that the Endovenous ablation has got a success rate of upwards of ninety per cent over five years. And the recurrence rate is pretty low compared to the traditional surgical approach.

So it sounds like it has a lot of benefits for the patient?

Exactly. Also. It has less pain compared to the surgical approach and that has been proven by studies as well. The cost to the community and to the patient as well as the down time being an office procedure there’s no downtime compared to surgical inpatient option.

OK so someone having the treatment what can they expect in relation to perhaps pain say?

During the procedure for laser for example which what we do in the Bondi Vein Clinic, Patient patients do not experience any kind of pain.
Patients do not experience any significant pain because part of the procedure we inject local anaesthetic, it’s called anaesthetic that is centred around the vein that has different has multiple benefits. One is to numb the vein to it also, 2) isolates the vein from the surrounding so there’s no collateral damage if you like and 3) it acts like a heat sink to keep the energy within the vein without moving to other issues.
Sometimes we ask people to take a couple of panadols if need be depending on the level of pain threshold in the next twenty four hours following the procedure.

So George I’ve heard that there are different types of Endovenous ablation. So what types are there Could you discuss that for our listeners?

Definitely Sean.

There is the, First type that came became available roughly around the turn of the century was the laser type and instead the name was Endovenous Thermal ablation because it utilizes heat.

And then shortly after the R.F. which is the radio frequency which in a way utilized the same principle and then more recently there are other types that are becoming available and there are gaining some traction on the way of treating the Endovenous ablation.

In the way of Endovenous ablation namely the glue and the make it, Mechanical. Chemical which is briefly called Mocha.

OK So tell us a bit more George about what other types of Endovenous ablation there are?

As mentioned Sean, the thermal ablation collectively called can be classified as two types the laser which is the traditional thermal ablation which is basically a thin laser fibre that gets inside the vein and as we as I mentioned earlier we inject to measure an ecstatic around the vein before we start the laser and as we activate a laser we pull back in a certain rate and as we watch it on the ultrasound as the laser works it basically seals the vein from within.
And that’s the procedure. The R.F. is very much similar but utilize the different technology instead of emitting laser it uses the radio frequency, as the reason as the source of energy given within the vein.

George are there any other types?

Yes as mentioned earlier there is the glue which is a newer kind of technology basically similar to the glue that is used to seal wounds of the skin in a way similar to the same molecule.

It comes loaded in the device and injected inside the vein and has the same effect in block in the vein.

More recently there is a newer method of ablation in the vein which utilizes both mechanical force as well as chemical by injecting sclerosant within the vein in the same setting basically the apparatus does mechanical rotation within the vein as it gets pulled out and in the meantime pushing some of the chemical sclerosant in the vein to produce the same effect.

So George what would the three take home messages be for our listeners today?

Basically there are newer technologies that are more effective and less painful and more practical options for the treatment of Varicose veins.
These technologies namely the Endovenous laser ablation, and the venous R.F. ablation, the endovenous seal using the glue and the Mechanical, chemical endovenous ablation. And the other thing is the most most of the guidelines or the current guidelines of the venous societies in advance world recommend the newer methods of endovenous ablation over surgery when available.

These technologies namely the Endovenous laser ablation, and the venous R.F. ablation, the endovenous seal using the glue and the Mechanical, chemical endovenous ablation. And the other thing is the most most of the guidelines or the current guidelines of the venous societies in advance world recommend the newer methods of endovenous ablation over surgery when available.

Good to be here.

Non-surgical Vs. Surgical vein treatment

Traditional vein surgery

People have been suffering with varicose veins and chronic vein diseases for thousands of years but until recently the treatment options have been limited.

Vein surgery for varicose veins in more recent years has involved ‘vein stripping’ where the entire greater saphenous vein of the leg is removed under general anaesthetic. The surgery involves many incisions and ligation and subsequently has an extended recovery period. Despite these shortcomings, it was the gold standard of surgery for varicose veins through the 20th century.

The latest in vascular sonography technology from GE (LOGIQ S7 with XDclear)

GE LOGIQ S7 with XDclearBondi Vein Clinic is excited to announce that we have acquired one of the latest technologies in vascular sonography from GE (LOGIQ S7 with XDclear). Its advanced technology enables us to visualise and diagnose even the tiniest incompetent veins with ease and accuracy. It also aids in successfully treating incompetent veins of any size with great precision.

Eat your way to better vein health

Did you know that with the right diet you could improve the health of your veins, help to prevent vein disease or even strengthen veins in need of support?
Unfortunately veins can become damaged over time, restricting blood flow and increasing the risk of chronic disease. However, with a balanced, healthy diet you can give your veins a shot of good health and improve your overall wellbeing.

Do’s and Don’ts for healthy leg veins


  • Walk regularly as steady walking helps the return of blood from leg veins. Ideally, you should walk 30 minutes daily for that purpose.
  • Take regular breaks if you tend to sit for long hours e.g. at work. By stretching and working your calf muscles and feet at regular intervals your help of venous blood back to the heart.
  • As a general rule drink plenty of fluids as hydration improves the circulation in the legs.
  • Wear compression stockings- if not medically contraindicated- especially for long haul travel or standing for long hours as they have been proven to help the return of venous blood. Use travel socks as an alternative if applicable.


  • Avoid standing in one position for long periods of time. If you have to stand for long at least, you can march in place from time to time to help pumping the venous blood out of the legs.
  • Avoid wearing high heels as much as possible as they can interfere with the calf muscle action that helps the return of venous blood from the legs while walking.
  • There has been a lot of debate about the effect (or otherwise) of crossing the legs on the leg veins. In general, it would be reasonable to say that sitting with crossed legs for extended periods of time does not help the inner calf veins to function properly especially for people who are susceptible to develop varicosities of these veins.
  • Smoking as it has toxic effects on the body tissues including leg veins.