Varicose veins affect up to 30% of the women and 20% of the men in the UK, that is, approximately 3 million people.  Genetic predisposition, the female hormonal cycle and hydrostatic pressure in late pregnancy are the predominant, recognised, causative factors. 

 

Varicose veins are caused by valve incompetence of the saphenous vein draining system of the skin of the legs.  As a result there is pooling of blood in the long veins and swelling of the distal tributary veins which become visible as bulging varicosities and cause symptoms of heaviness, pain, itching and generalised oedema.  The impaired venous return is detrimental to the skin of the calves and ankles resulting in hair loss, discolouration, eczema and ultimately, ulceration. 

Early treatment, before these secondary consequences have become established, achieves the best results.

 

 

Assessment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Choosing the optimum treatment regimen depends on accurate assessment of the pattern of venous incompetence. At consultation, a full history and examination is undertaken.  Venous duplex ultrasound is essential to elucidate the pathways of venous incompetence and discover complicating factors such as dual veins, aberrant connections, pudendal veins and the results of previous surgery.

 

1.Surgery

Conventional treatment involves stripping of the veins by surgery under general anaesthetic. This may be carried out on a day-case basis, or more commonly with an overnight stay, with the patient returning to full normal activities 3-6 weeks later. Stripping carries the risk of numbness of the thigh or ankle due to skin nerve damage in up to 11% and a recurrence rate of up to 10% at 1 year rising to 20% at 5 years. Bruising and discomfort commonly may persist for 3-6 weeks following surgery.

2. Sclerotherapy

Outpatient injection of sclerosant solution (Sclerotherapy ) is commonly used after laser treatment of the main incompetent veins (or surgery where it replaces phlebectomy) to complete the treatment of the smaller varicose and spider veins.

 

3. Endothermal Laser ablation treatment for varicose veins (ELVeS/EVLT/VNUS)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

With an estimated 50,000 cases of varicose veins treated every year in the UK but an estimated prevalence of 250,000 symptomatic cases, it appears that many people are not coming forward for treatment. In particular the prospect of up to 6 weeks off work following surgery is off-putting for many working people. However, Laser Treatment is now available allowing return to normal activities within 24 hrs with results better than surgery.

The EndoLaser Vein System (ELVeS) was FDA-approved in 2002 and is CE-marked 

The NICE guidelines of July 2013 are now available confirming Endothermal laser ablation treatment for varicose veins as the first choice in treatment for Varicose Veins.

Endovascular laser techniques have been developed that remove the need for stripping out the saphenous vein by cauterising the vein in-situ, resulting in its fibrosis. 

The vein is localised and catheterised under ultrasound guidance. A laser fibre is placed at the sapheno-femoral junction at the groin and withdrawn slowly while delivering the laser energy at the tip.

Protein coagulation of the vein wall results in instant contraction of the vein, closing it around the withdrawing fibre. The vein remains closed and fibroses and disappears over the following weeks

 

In the Minimally Invasive Treatment Unit (MITU) located on the third floor of 149 Harley Street, the procedure is carried out under local tumescent anaesthesia and takes less than 1 hour.

The patient can stand and walk at the end of the procedure. Wearing a compression stocking for a week following the treatment, they can return to normal daily activities and work, almost immediately.

 

Results

The reported successful closure rate is 97% in a meta-analysis of over 2,000 patients treated by laser ablation, with no late recurrence at up to 5 years follow-up.  Patients avoid the risks and complications associated with general anaesthesia, hospitalization and surgical complications and there is no scarring. Patients can return to normal activities and work within 24 hours.

 

We offer Endothermal ablation (Laser) treatment (ELVeS) as a minimally-invasive alternative to surgery. Under local anaesthetic, it takes less than 1 hour with immediate return to normal activities.

With 98% success at 5yrs follow-up (c.f. surgery 20% recurrence at 5yrs) it may also encourage earlier treatment and so help reduce the incidence of secondary complications such as venous ulceration.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Example Patient Information Letter