Varicose Veins & Pelvic Congestion

Varicose veins are traditionally considered to be lumpy veins in the legs, which are only a cosmetic problem. Unfortunately, both of these considerations are incorrect.

Although about 15 to 20% of the population have varicose veins bulging in the legs, another 15 to 20% have “hidden varicose veins”.

Varicose veins are never “just cosmetic”. Every year, 4-5% of patients with varicose veins deteriorate. This deterioration goes from varicose veins to swollen legs, discolouation on the legs, eczema or venous leg ulcers. Other deterioration can include clots in the veins, or, more rarely, bleeding from the veins.

It is now national guidelines (NICE CG168) that anyone with varicose veins (or hidden varicose veins), and any of the following, should be referred for a venous duplex ultrasound scan and treatment:

• tired or aching leg on standing
• swelling of the ankle
• red or brown skin stains around the lower leg
• eczema or ulcers over the veins or lower leg
• bleeding from, or a hard, lumpy varicose vein

It has now been shown that it is impossible to assess varicose veins, or hidden varicose veins, without a venous duplex ultrasound scan. Therefore, it is vital to have one.

Furthermore, research shows very clearly that over 150 veins in each leg can cause varicose veins – and indeed any combination of these veins.

It is part of The Whiteley Protocol® that every patient has both legs scanned by a Whiteley Clinic-trained vascular technologist using our protocols. We ensure that we scan all three of the major truncal veins, all 150 perforators, and look for any signs of any pelvic varicose veins coming into the legs. Pelvic veins are a major cause of leg varicose veins in 1 in 6 women and 1 in 30 men.

Not identifying & treating incompetent perforating veins or pelvic varicose veins is the most frequent cause of recurrent varicose veins after treatment.

The Whiteley Clinic has become world famous for being at the forefront of treatments for varicose veins.

Professor Mark Whiteley was the first person in the UK to perform the new endovenous surgery that burns veins through a pinhole rather than stripping veins out. The old stripping procedure was painful and useless as most veins only grow back again. When veins grow back again, they never have valves and hence are always varicose veins.

The new pinhole endovenous surgery is less painful, performed under local anaesthetic and if it is performed correctly, the risk of varicose veins returning drops dramatically.

Research performed over the last 20 years at The Whiteley Clinic has shown that no single treatment is better than any other for varicose veins. Instead, each different vein has a different optimal treatment technique depending on its size, position and depth from the skin. Hence The Whiteley Protocol®. This research-based protocol suggests the best sequence of treatments to get the optimal result for each pattern of vein problems, ensuring the lowest recurrence rate.

If you come to The Whiteley Clinic at The Clinic @78 in Bournemouth, you will be assessed by a consultant trained in The Whiteley Protocol®. In addition, you will have a venous duplex ultrasound scan performed by a Whiteley Clinic-trained vascular technologist.

Once the consultant has assessed your symptoms and signs clinically and they have the results of the scan, they will be able to recommend the optimal sequence of treatments for your particular pattern of vein problems by following the Whiteley Protocol®.

Options that may be suitable may include combinations of:

• Endovenous laser ablation (EVLA) or Sonovein (High Intensity Focused Ultrasound HIFU)
• TRLOP closure of perforators
• Coil embolisation of pelvic veins
• Ambulatory phlebectomy
• Ultrasound-guided foam sclerotherapy
• Microsclerotherapy

Other techniques are also available but are not commonly recommended to our patients

Checking the results of treatment – The College of Phlebology Venous Registry

The Whiteley Clinic was the founding organisation for the College of Phlebology Venous Registry, and all of the doctors at The Whiteley Clinic are members of this registry. All patients are asked for consent for their anonymous data to be added to the registry. In this way, all of our patients can be certain that our results are being checked. In addition, any poor results can be highlighted and traced back to the doctor and the technique used.

Thread veins of the legs affect approximately 80% of adults. They are different from thread veins that affect the face and are investigated and treated very differently.

Facial thread veins can be assessed by looking at them.. Treatments for facial thread veins include electrolysis/radiofrequency needles, intense pulse light (IPL) or lasers.

Treatment for leg thread veins, however, should only be considered after a venous duplex ultrasound scan of the underlying leg veins.

Research has shown that almost 9 out of 10 patients with leg thread veins have underlying hidden varicose veins causing them. Medically, this is called “venous reflux”.

Treating the leg thread veins without finding and fixing the underlying reflux is not a good idea. At best, the veins will recur soon after any treatment. At worst, a permanent red mark called “telangiectatic matting” will occur.  This is only found when underlying reflux has not been found or treated.

Treatment involves fixing any underlying reflux first, followed by microsclerotherapy. Microsclerotherapy is the injection of a liquid into the veins using a tiny needle and magnification. It pushes the blood out of the vein, destroying the vein wall.

Over the next three weeks, the vein shrivels away, provided it is kept empty. Hence it is essential to wear compression stockings day and night for three weeks to get the best results.

The electrolysis/radiofrequency needles do not work well on leg thread veins.

Remember, Leg Thread Veins:

• are completely different from facial thread veins
• should only be treated after a venous duplex ultrasound to check for any underlying cause. The underlying cause must be treated first
• compression must be worn for three weeks day and night after microsclerotherapy for best results