Vascular Surgery in Melbourne: Expert Care Across the Full Spectrum
Vascular disease does not announce itself in one way. For some patients it begins as a ropey cluster of veins behind the knee. For others, it arrives as a cramping pain in the calf after a short walk, or as a silent aneurysm found on a scan done for something else entirely. What these presentations share is a problem within the vascular system: the network of arteries, veins, and lymphatics that keeps every organ, limb, and tissue supplied. When that network starts to fail, timely specialist assessment can be the difference between a straightforward intervention and a serious long-term complication.
At Adeney Private Hospital in Kew, Dr Lachlan Maddock, MBBS, FRACS (General Surgery), FRACS (Vascular Surgery), brings dual-fellowship expertise to the full range of vascular conditions. As a Fellow of the Royal Australasian College of Surgeons in both general and vascular surgery, Dr Maddock is among a small number of dual-trained vascular surgeons practising in Melbourne.
What Is Vascular Surgery?
Vascular surgery is the specialty focused on diagnosing and treating diseases of the blood vessels, arteries, veins, and the lymphatic system, outside the heart and brain. It covers a wide clinical range: from the commonplace (varicose veins) to the urgent (aortic aneurysms and stroke-risk carotid disease).
There are two main surgical approaches. Open surgery involves a direct incision to repair or bypass a diseased vessel. Endovascular surgery, increasingly used where anatomy allows, works from the inside, with catheters and stents navigated through small incisions under real-time imaging. Dr Maddock holds fellowship qualifications in both from the Royal Australasian College of Surgeons (RACS) and is a member of the Australia and New Zealand Society of Vascular Surgeons (ANZSVS). This dual-trained background means he can manage not only the vascular condition but also the broader surgical context that often accompanies it.
Common Signs You Should See a Vascular Surgeon
Vascular conditions vary widely in severity, some are mild and manageable with lifestyle changes, while others require prompt intervention. Either way, early assessment matters. Many vascular problems are easier to treat before complications develop, and some conditions, such as aortic aneurysms, carry serious risks if left undetected. It is worth asking your GP for a referral to a vascular surgeon if you experience any of the following:
- Leg pain or cramping that comes on when you walk and eases with rest
- Visible varicose veins, particularly if accompanied by aching, heaviness, or swelling in the legs
- Persistent leg swelling that does not improve with elevation
- Cold feet, numbness, or a pale or bluish colour in the lower limbs, signs of poor circulation
- A wound on the foot or lower leg that has been slow to heal, especially if you have diabetes
- A diabetic foot ulcer, no matter how minor it appears
- A known or suspected aneurysm that has not yet been formally assessed
- A recent episode of sudden weakness, slurred speech, or loss of vision, even briefly, which may indicate a transient ischaemic attack (TIA), sometimes called a mini-stroke
Not every vascular condition requires surgery. Many patients are managed effectively with medication, compression, lifestyle adjustment, or surveillance. But a proper assessment is the only way to know where you stand, and early diagnosis generally leads to better outcomes.
Is Vascular Disease Serious?
That depends on the condition. Varicose veins, for example, are very common and in many cases cause only cosmetic concern or mild discomfort. They are rarely life-threatening. But left untreated, they can progress, leading to chronic leg heaviness, skin changes, and ulcers that are difficult to heal.
Other vascular conditions carry higher stakes. Peripheral arterial disease, if unmanaged, can advance to a point where the blood supply to a limb is critically reduced. Carotid disease can cause stroke. An aortic aneurysm that ruptures without warning carries a mortality rate exceeding 80%.
What these conditions share is that they respond best to early intervention. The patients who do well are typically those who sought assessment before the condition reached a critical point, not those who waited until symptoms became severe. If something feels off with your circulation, legs, or healing, a conversation with your GP about a vascular referral is a sensible first step.
Varicose Veins and Chronic Venous Disease
Varicose veins are the most common reason patients seek vascular surgical review. They develop when the one-way valves inside the superficial leg veins fail, allowing blood to pool in the lower limb rather than return efficiently to the heart.
What are the symptoms of varicose veins?
Varicose veins appear as visibly enlarged, twisted veins, typically on the back of the calf or inner thigh. Beyond appearance, symptoms include aching, heaviness, and swelling in the legs, particularly after standing for long periods. Skin around the ankle can become discoloured or thickened over time, and in advanced cases venous ulcers develop. These are medical complications, not cosmetic concerns.
Many patients are surprised to learn that varicose veins reflect an underlying venous insufficiency, and without treatment, that insufficiency tends to worsen. The skin changes and ulceration that can follow are genuinely difficult to manage once established, which is why earlier treatment is generally preferable.
Dr Maddock offers the full range of evidence-based venous treatments:
● Endovenous Laser Ablation (EVLA): a fine catheter is placed inside the faulty vein and delivers laser energy that thermally seals it shut, guided by real-time ultrasound.
● Radiofrequency Ablation (RFA): uses controlled heat to close the vein, with outcomes comparable to EVLA and strong long-term results.
- Ultrasound-guided foam sclerotherapy: a sclerosant agent is injected into the vein, triggering a controlled response that permanently closes it.
- Conventional surgical stripping: reserved for complex or recurrent cases where minimally invasive techniques are not appropriate.
Most venous procedures are performed under local anaesthesia as day surgery. Patients are typically walking the same day.
Peripheral Arterial Disease and Atherosclerosis
Peripheral arterial disease (PAD) develops when atherosclerosis, the gradual build-up of fatty deposits within artery walls, narrows the vessels supplying the legs, reducing blood flow to the muscles and tissues below.
What are the symptoms of peripheral arterial disease?
The most recognisable symptom is cramping leg pain when walking (known medically as intermittent claudication), a heaviness or ache in the calf, thigh, or buttock that comes on predictably with exercise and clears after a short rest. It is frequently mistaken for arthritis or muscle strain. As PAD advances, wounds on the feet heal poorly, and blood flow may become so reduced it threatens the limb, a condition known as critical limb ischaemia.
The same risk factors that drive heart disease also fuel PAD. According to the Heart Foundation, smoking, high blood pressure, high cholesterol, and diabetes are major modifiable cardiovascular risk factors, all of which significantly increase the likelihood of developing peripheral arterial disease. The Australian Institute of Health and Welfare confirms that cardiovascular conditions remain the leading cause of death in Australia.
Treatment depends on severity. Milder cases are managed with cardiovascular risk reduction, supervised exercise, and antiplatelet medication. More significant obstruction may require endovascular angioplasty and stenting, or arterial bypass surgery, to restore adequate blood flow.
Arterial Aneurysms
What is an abdominal aortic aneurysm?
An abdominal aortic aneurysm (AAA) is an abnormal bulge in the aorta, the main artery of the abdomen, below the level of the kidneys. It forms when the artery wall weakens and expands beyond its normal diameter. Most AAAs cause no symptoms, which is why they often go undetected. Men over 65 with a history of smoking are at significantly elevated risk and should ask their GP about screening.
What are the symptoms of an aortic aneurysm?
Most people with an AAA have no symptoms at all, the aneurysm is typically discovered incidentally during a scan performed for another reason. This silence is part of what makes it dangerous: rupture can occur without warning and carries a mortality rate exceeding 80%. Occasional cases present with abdominal or back pain, but this is uncommon.
Once an aneurysm reaches a size where the risk of rupture outweighs the risk of repair, typically around 5.5 cm, intervention is recommended:
- Endovascular Aneurysm Repair (EVAR): a stent-graft is placed inside the aneurysm via the femoral arteries under imaging guidance, sealing the sac from arterial pressure. EVAR generally carries lower operative risk in suitable patients and allows a faster recovery.
- Open surgical repair: preferred for cases where anatomy is not suitable for endovascular techniques, with durable long-term results.
Carotid Artery Disease and Stroke Prevention
The carotid arteries supply oxygenated blood to the brain. When atherosclerotic plaque builds up at the point where the carotid divides in the neck, a fragment can break off and travel to the brain, or the artery may narrow so significantly that blood flow is reduced, both of which can cause a stroke or a transient ischaemic attack (TIA), sometimes called a mini-stroke.
What are the symptoms of carotid artery disease?
Carotid disease is often silent until a TIA or stroke occurs. Warning signs of a TIA include sudden weakness or numbness on one side of the body, difficulty speaking, brief loss of vision in one eye, or loss of balance. These symptoms may resolve within minutes, but a TIA is still a medical emergency, and urgent vascular assessment is essential. Prompt treatment substantially reduces the risk of a subsequent full stroke.
Carotid endarterectomy (CEA) removes the plaque from the artery wall through a neck incision, restoring blood flow and reducing stroke risk, particularly when performed promptly after the presenting event. Carotid artery stenting is an endovascular alternative for patients where open surgery carries a higher risk.
Chronic Wounds, Diabetic Foot, and Vascular Ulcers
Chronic non-healing wounds are among the most complex presentations in vascular surgery, most often seen in patients with diabetes, peripheral vascular disease, or both.
What causes diabetic foot ulcers and why do they require vascular assessment?
Diabetic foot ulcers develop when nerve damage removes protective sensation, reduced arterial blood flow limits the body’s ability to heal, and an impaired immune response increases infection risk. Even a small graze can progress to deep ulceration or bone involvement, often without the patient feeling significant pain. Without timely vascular assessment and revascularisation where needed, limb loss is a real and frequently preventable outcome.
Venous ulcers, typically appearing above the inner ankle with brownish skin discolouration from longstanding venous disease, require the same root-cause approach. Dr Maddock assesses and manages both arterial and venous ulceration, coordinating revascularisation with wound care, endocrinology, and infectious disease teams as required.
Vascular Surgery at Adeney Private Hospital
Adeney Private Hospital in Kew is one of Melbourne’s newer private hospitals, purpose-designed for specialist surgical care. For vascular patients this means on-site I-MED Radiology for duplex ultrasound and vascular imaging, and Melbourne Pathology for all pre- and post-operative testing, both accessible under one roof.
Adeney works with all major private health insurers. Eligible Medibank and Bupa members may access selected procedures with zero out-of-pocket costs. Cost information is provided clearly before any procedure is booked. For details, visit the Vascular Surgery page or the Private Health Insurance page on the Adeney website.
What Happens at Your First Vascular Consultation?
At your first appointment, Dr Maddock will review your symptoms and medical history in detail. A physical examination follows, typically including a circulation assessment such as an ankle-brachial index, which measures blood pressure at the ankle and arm to gauge how well blood is flowing to your legs. Duplex ultrasound imaging can often be arranged on-site
at Adeney’s I-MED Radiology if further information is needed. Once the assessment is complete, treatment options are discussed openly. Many patients leave with a conservative management plan rather than a surgical one, the right path depends entirely on what the assessment finds.
When to Seek a Vascular Surgical Referral
A referral to a vascular surgeon is worth considering when any of the following are present:
● Visible varicose veins with associated pain, heaviness, swelling, or skin changes
● Cramping leg pain that comes on predictably with walking and eases with rest
● A known or incidentally detected arterial aneurysm requiring assessment or surveillance
- A recent TIA or stroke with known or suspected carotid narrowing
- Diabetes with foot ulcers, non-healing wounds, or concern about lower limb circulation
- Non-healing wounds on the lower leg or foot without a clear cause
- An abnormal ankle-brachial index identified on vascular assessment A GP referral is required for Medicare rebates to apply. Dr Maddock accepts referrals to his consulting rooms at Epworth Eastern (Box Hill) and Holmesglen Private Hospital (Moorabbin), with surgery performed at Adeney Private Hospital in Kew. GPs can find referral information on the GP Referrer Information page.
Frequently Asked Questions
What does a vascular surgeon treat?
A vascular surgeon diagnoses and treats diseases of the blood vessels, arteries, veins, and lymphatics, throughout the body, excluding the heart and brain. This includes varicose veins, peripheral arterial disease, aortic and peripheral aneurysms, carotid artery disease, and chronic wounds related to poor circulation.
When should I see a vascular surgeon?
If you have leg pain when walking, visible varicose veins with swelling or skin changes, a non-healing wound on the foot or lower leg, a known aneurysm, or have recently experienced symptoms of a TIA, a referral to a vascular surgeon is worth discussing with your GP. Many conditions are easier to treat when identified early, and not every referral leads to surgery.
Are varicose veins dangerous?
For most people, varicose veins are not immediately dangerous, but they are not simply a cosmetic issue. They signal an underlying venous insufficiency that tends to worsen without treatment. Over time, this can lead to chronic leg pain, swelling, skin changes, and venous ulcers that are difficult to heal. Early assessment can prevent these complications from developing.
What is an abdominal aortic aneurysm?
An abdominal aortic aneurysm (AAA) is an abnormal bulge in the aorta, the main artery of the abdomen, below the kidneys. Most AAAs cause no symptoms and are found incidentally on scans. If left undetected until rupture, the mortality rate exceeds 80%. Screening is recommended for men over 65 with a history of smoking.
What are the symptoms of peripheral arterial disease?
Peripheral arterial disease typically causes cramping leg pain when walking, usually in the calf, thigh, or buttock, that eases with rest. Other symptoms include leg fatigue, slow-healing wounds on the feet, and in severe cases, pain at rest. The condition is closely linked to smoking, diabetes, high blood pressure, and high cholesterol.
What causes poor circulation in the legs?
The most common cause is peripheral arterial disease, where fatty deposits narrow the arteries supplying the legs. Chronic venous disease, where faulty vein valves cause blood to pool, is another frequent cause. Diabetes-related vascular damage, blood clots, and less commonly vasculitis can also reduce circulation. A GP or vascular surgeon can arrange the relevant tests.
Can vascular disease be treated without surgery?
Yes, in many cases. Milder peripheral arterial disease is often managed with risk factor modification, supervised exercise, and medication. Varicose veins can sometimes be managed with compression stockings, though minimally invasive procedures are available when symptoms warrant it. Whether surgery is appropriate depends on the condition, its severity, and your overall health. A consultation is the best way to understand what applies to your situation.
Is vascular surgery covered by Medicare and private health insurance?
Most vascular surgical procedures carry Medicare Benefits Schedule item numbers, meaning Medicare rebates apply. If you hold private hospital cover, your insurer may cover a significant portion of the remaining costs. Eligible Medibank and Bupa members may access certain procedures at Adeney Private with zero out-of-pocket costs. Confirm your exact entitlements with your insurer once your surgeon provides the relevant procedure item numbers.
Do I need a GP referral to see a vascular surgeon?
Yes. A current GP or specialist referral is required for Medicare rebates to apply to your consultation and any subsequent procedure. If you are experiencing vascular symptoms, speak with your GP about a referral to Dr Maddock at Adeney Private Hospital.
Is vascular surgery painful?
Most patients find recovery more manageable than expected, particularly after minimally invasive procedures. Endovenous treatments for varicose veins are performed under local anaesthesia and cause minimal discomfort. Open arterial surgery involves a more significant recovery period, and Dr Maddock will discuss what to expect in your specific case well before any procedure is scheduled.
What is the difference between open and endovascular surgery?
Open vascular surgery involves a direct incision to repair or bypass a diseased blood vessel. Endovascular surgery treats the vessel from the inside, using catheters, stents, and other devices guided through small groin incisions under imaging. Endovascular techniques generally mean less operative stress and a faster recovery, though not every condition or anatomy is suited to this approach.
How long does recovery take after vascular surgery?
It depends on the procedure. After minimally invasive venous procedures such as laser ablation or sclerotherapy, most patients return to normal activities within a day or two. Open arterial surgery, such as aortic repair or bypass, may require a hospital stay of several days and a recovery period of four to eight weeks. Dr Maddock will walk you through what to expect at your pre-operative consultation.
Where is Adeney Private Hospital?
Adeney Private Hospital is at 209 Cotham Road, Kew VIC 3101, in Melbourne’s inner east, accessible from Hawthorn, Balwyn, Camberwell, and surrounding suburbs, with on-site parking and public transport access.
Book a Vascular Surgical Consultation
If you have a GP referral and are considering vascular surgical care at Adeney Private, visit the Vascular Surgery page on the Adeney website, or contact Dr Maddock’s rooms directly on (03) 8060 4271. Adeney Private Hospital is at 209 Cotham Road, Kew VIC 3101. GPs can find referral instructions on the GP Referrer Information page.