URGENT MEDICAL ATTENTION

URGENT MEDICAL ATTENTION If you have an urgent matter that you need to discuss with Mr Ling please contact (03) 9024 6867.

FREQUENTLY ASKED QUESTIONS

A carotid endarterectomy is an operation on the main arteries in the neck that supply blood to the brain. The operation is performed in order to prevent a stroke or a transient ischaemic attack (TIA or mini stroke). It involves removing the build up of plaque within the carotid arteries in order to prevent it from dislodging into the brain’s circulation.

Thrombophlebitis is the inflammation of a vein. It often presents as a red, hot and tender cord in the vein which runs along the inside of the thigh. Options for treatment include just traeting with blood thinners such as warfarin or clexane, or alternatively, having surgery to tie off the junction between the inflamed vein and the deep vein in the groin. This prevents the clot from dislodging and embolising into the lung (known as a pulmonary embolus or PE), which can be life-threatening. The optimal treatment for you may be different to someone else, so it is important to have a balanced discussion about the advantages and disadvantages with Mr Ling, who will advise you about what would be best for you. 

DVT is an acronym for Deep Venous Thrombosis. It is a blood clot in the deep veins of the legs. Mr Ling will manage this condition by first performing a thorough history and examination to determine the cause of the DVT. He will order any necessary investigations and then commence treatment to prevent complications such as a pulmonary embolus or, in other words, a blood clot dislodging and embolising into the lung.

Mr Ling works as part of a team of specialists involved in the care of people with diabetes. His work includes improving blood flow to the feet, surgical management of chronic ulcers, wounds and gangrene and the prevention of further complications.

Mr Ling works in collaboration with your kidney specialist to perform the surgical procedures required for dialysis (such as creation of an arteriovenous fistula, insertion of a Tenckhoff catheter or Permacath).

An aneurysm is a blood vessel that has enlarged like a balloon. Aneurysms commonly occur in the abdominal aorta (known as an abdominal aortic aneurysm or ‘AAA’), the thoracic aorta (known as a thoracic aneurysm) and in the arteries behind the knee (known as a popliteal aneurysm). They require treatment to prevent them from rupture or bursting and/or to prevent them from showering their contents into blood vessels down stream (known as embolisation) which results in blockage of blood flow.

Aneursyms can be treated by open surgery or endovascular surgery. The method of treatment adopted will depend on many factors, including the anatomy of the aneurysm, its location, its size, how accessible it is, the status of the patient’s heart, lung and kidney function and so on. Mr Ling will discuss with you and your family how these and other factors impact on your particular situation and will ultimately advise you on the best course of action based on your circumstances.

An angiogram is essentially an ‘xray’ of the arteries. It involves the use of a contrast agent that is injected into a blood vessel (usually via a needle in the groin artery under local anaesthetic) while a machine takes pictures or xrays.

An angioplasty involves the use of a balloon which is inserted under xray guidance through a narrowing (stenosis) or blockage (occlusion) of a vessel. It is inflated to widen the diameter of the vessel, allowing blood to pass more easily.

A stent is a special fine metal cage that is used to hold open a vessel. It is inserted under xray guidance through a narrowing of an artery and then it is expanded under xray guidance to widen the artery.

1) Sclerotherapy

Sclerotherapy can also be used in the treatment of ‘spider veins’. Using a very fine needle, a chemical irritant (sclerosant) is injected into the veins to cause an inflammatory reaction and result in vessel wall irritation. This causes the vessels walls to become adherent and to close. The number of injections required depends on the amount of ‘spider veins’ that need injecting – there is also only a certain amount of sclerosant that can be administered safely in a 24 hour period and this may mean you may require more than one treatment session. 

Mr Ling offers the following treatments. Each option carries with it advantages and drawbacks, which Mr Ling will discuss with you before recommending a management plan.

Conservative treatment

Conservative treatments might include wearing a properly measured and fitted compression stocking (if you have poor circulation or peripheral vascular disease further investigation of your arterial supply is required before wearing the stockings) and using an aqueous moisturising cream to protect skin if it is dry, flaky or itchy.

Therapeutic treatment

Until recently, surgery was the gold standard for treatment of truncal varicose veins, which involved high ligation and stripping of the long saphenous vein.

However, endovenous thermal ablative techniques have now been developed to reduce problems associated with conventional
surgery and stripping (bruising, infected wounds, scarring, haematoma, recurrent inguinal neovascularisation, and prolonged
incapacity). Mr Ling is able to offer several minimally invasive treatments that are done as day procedures. The best treatment for you will be discussed during your consultation.

  1. Radiofrequency Ablation

    Radiofrequency ablation is able to be performed as a day procedure. The radiofrequency waves cause local heating and therefore damage to the vein wall. In order to protect surrounding tissues from heat damage, local anaesthetic mixed with saline is also injected around the vein (tumescent anaesthesia).

    Advantages of radiofrequency ablation:

    1. Less post-procedural pain than surgery and endovenous laser.
    2. Less bruising and tenderness than surgery and endovenous laser.
    3. Faster recovery to normal activity and faster return to work compared with surgery and endovenous laser.
    4. Additional advantages of having it done by Mr Ling in a private hospital day procedure setting:

    5. In mid-2013, Radiofrequency ablation was included on the Medicare Benefits Schedule. Therefore, by having it done in a private hospital (still as a day procedure), privately insured patients save thousands of dollars by having their procedure largely covered by Medicare and private health insurance. This is possible because it avoids the expensive ‘facility fee’ that ‘vein clinics’ charge patients because private funds will not rebate them. 
    6. Patients can elect to have the procedure under a local or general anaesthetic. With a general anaesthetic the advantages are avoidance of multiple injections for tumescent anaesthesia and one can have the varicose veins removed by multiple phlebectomies without needing further needles for local anaesthetic (as they would in a vein clinic). Furthermore, this removes all of the varicose veins in a SINGLE treatment session and negates the need for multiple subsequent ambulatory phlebectomies and/or sclerotherapy (as would be the case in vein clinics). 
    7. The patients are admitted as a day case but can also elect to stay overnight if desired.
  2. Endovenous Laser Therapy

    Laser treatment is able to be performed as a day procedure. It uses heat energy from a laser probe that is inserted into the vein under local anaesthetic. In order to protect surrounding tissues from heat damage, local anaesthetic mixed with saline is also injected around the vein (tumescent anaesthesia).

    The advantages of laser include being able to resume normal activities on the same day, no requirement for general anaesthesia, decreased bruising and good long term results. 

    The Australian Government has approved Endovenous Laser Therapy to be rebated by Medicare as of November 2011. Therefore people with private insurance can have the procedure done in a private hospital without extremely large out of pocket expenses for ‘facility fees’ that clinics tend to charge. (See above under Radiofrequency Ablation). 

  3. Sapheon Glue (VenaSeal) 

    A great alternative – it does not involve heat treatment like laser and radiofrequency ablation. It is a new technique and so long term results are not available. However, short term results have been comparable to other treatments. 

  4. Surgery

    Surgery has been the gold standard of treatment for centuries, and still remains one of the recommended treatments for varicose veins. It still plays a role in certain circumstances where heat treatment with laser or radiofrequency ablation and sclerotherapy are not suitable. Mr Ling will discuss the best treatment option for your clinical picture. 

  5. Sclerotherapy

    Sclerotherapy has long been used in the treatment of varicose veins. It involves the use of a very fine needle to inject sclerosant, which is an irritant to the vessel wall. This causes the vessel walls to stick together.  The lack of blood flow results in the disappearance of the vein or venule. The procedure causes minimal discomfort because only very fine needles are used. It can be used to treat tiny spider veins but long term results for treatment of large veins are not very good. 

The indications for treating varicose veins include:

  1. Medical complications:
    1. skin changes – discolouration (brown pigmentation), venous eczema (itching), lipodermatosclerosis (fibrosis and hardening of the fat layer under the skin, causing thickened and red skin)
    2. ulceration
    3. thrombophlebitis (clotting and acute inflammation of a vein)
    4. bleeding from a traumatized vein.
  2. Symptoms such as aching, throbbing or tenderness of the veins
  3. Cosmetic appearance – many people are embarrassed by the appearance of their legs. This causes significant impairment to one’s quality of life.

It may be entirely reasonable to leave varicose veins, particularly minor ones, untreated. A consultation with Mr Ling will clarify whether your varicose veins should be treated, and recommendations will be made after carefully balancing the expected benefits of treatment against its disadvantages.

It is necessary to bring a referral letter from your General Practitioner to initial consultations.

Other things to bring include:
An updated list of your medications
Any scans and/or reports relating to your condition

It is often helpful to have a close relative or friend attend with you when discussing your management plan, as you may not remember everything that is said. Information pamphlets and direction to appropriate literature such as recommended websites can also be provided to ensure you are fully informed.

Mr Ling prefers to meet you at a subsequent consultation prior to booking a procedure, so that you have sufficient time to consider the options and recommendations given to you. It helps if you write down any questions you have so you can ask Mr Ling at the next consultation.

Some treatments can then be performed in Mr Ling’s consulting rooms without the need to attend an operating theatre and undergo an anaesthetic. However, if you are having a procedure performed in the rooms, it is still advisable to have someone drive you home.

During consultations, Mr Ling will conduct a thorough and comprehensive history and physical examination and may perform some simple and painless bedside tests. It may be necessary to then order investigations (blood tests, ultrasounds or CT scans) to aid in the diagnosis and treatment of your condition. A detailed management plan taking into account your health concerns, expectations, the level and severity of disease and the risks and benefits of various treatment options is offered once all necessary information is available. Therefore, it may be necessary to see you again after certain tests are performed.