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Monday 30 April 2012

Early venous eczema from Varicose Veins

Many people are put off from have their varicose veins treated by doctors, nurses or even just "friends" who erroneously tell them that "Varicose Veins" are just cosmetic".
Varicose veins which have been left for years starting to damage the skin
as evidenced by the onset of Venous Eczema
Unfortunately for the patients who listen, varicose veins are usually the sign that the major truncal veins in the legs have lost their valves, and that the blood is falling back down the veins rather than being pumped up to the heart.

This falling blood (called "venous reflux") impacts on the skin capillaries, and over years causes damage and inflammation.

This patient had left her varicose veins for years, and over the last 12 months, started to notice her ankle was swelling by the end of the day.

Over the last 3 months, an itchy red patch has appeared just below the varicose veins - that she finds she scratches when asleep preventing it from healing.

This is early venous eczema - and the only cure for it is to have the varicose veins scanned and treated effectively - stopping the venous reflux and making the blood pump the right way up the leg veins.

Thursday 26 April 2012

Perfecting results of varicose vein surgery with RFiTT

George Badham - Whiteley Clinic Summer Research fellow in 2010
Results of RFiTT presented at The Venous Forum April 2012
The RFiTT procedure for treating varicose veins was introduced over 5 years ago as a new technique for "keyhole" varicose vein surgery.

The Whiteley Clinic initally would not use the device as the initial results were disappointing compared to the near perfect results that we expect by treating patients by The Whiteley Protocol(TM).

In Summer 2010, George Badham, a Whiteley Clinic summer research fellow and Cardiff Medical student, preformed a prize winning research study to show how the recommended treatment technique was sub-optimal and he showed how to modify this to optimise the procedure (The Whiteley Clinic Method).

George used a model to perform his research - but of course this doesn't necessarily mean that the optimised technique would work in patients.

Therefore George has analysed one year of patients treated with his optimsed technique - "The Whiteley Clinic Method" - and is presenting his research as a poster at The Venous Forum this week in the Royal Society of Medicine in London.

In this work, George Badham has shown that using his modification to the technique, we have managed to get 100% closure of the treated Great Saphenous Vein at one year - perfect results!

We would recommend that anyone using RFiTT in the treatment of Varicose Veins should use The Whiteley Clinic Method as described by George Badham, to ensure that they get optimal results for their patients.  

Wednesday 25 April 2012

Reducing costs of endovenous surgery

Maria Boland - Whiteley Clinic summer research fellow 2009 

This week, Maria Boland will be presenting her research about endovenous surgery at The Royal Society of Medicine in London, at the Venous Forum meeting.

Maria, a medical student and summer research fellow at The Whiteley Clinic in 2009, has assisted in a project analysing how endovenous surgery under local anaesthetic has changed in The Whiteley Clinic since 2005.

Her research has monitored how since endovenous surgery started being performed under local anaesthetic, the amount of work that can be done in local anaesthetic session has increased. This has been due to a combination of new procedures and improved techniques.

As one of the world's leading vein clinics, The Whiteley Clinic experience has shown that they can keep the same excellent high standards of treatment, with excellent patient satisfaction scores and yet have:
  • Reduced the number of endovenous devices used per patient
  • Increased the amount of work that can be done per local anaesthetic session
  • Decreased the number of sessions needed to treat patients
These changes have meant that The Whiteley Clinic is able to reduce the costs of endovenous surgery without any decrease at all on the quality of their work.

Maria's Poster will be on display at The Venous Forum this week at The Royal Society of Medicine and will be called:

"5 year audit of number of visits and endovenous devices required for walk-in walk-out endovenous surgery for varicose veins under local anaesthesia"

M.Z. Boland, B.A. Price, M.S. Whiteley

Sunday 22 April 2012

Warning - Varicose veins coming from Pelvic Veins

This lady, who presented to The Whiteley Clinic with varicose veins, typifies a problem that we are seeing very commonly.

Although her varicose veins appear to be in the legs, when she was scanned by the expert Vascular Technologists at The Whiteley Clinic, it was found that all of her underlying leg veins were normal - and all of the visible varicose veins come from "hidden varicose veins" in the pelvis.
Left leg varicose veins - however scan showed the underlying causes was from Pelvic Veins only. Surgery to the leg varicose veins (Stripping, Laser, Radiofrequency, etc) would NOT have worked
Had this lady gone to a normal varicose vein clinic or seen a normal varicose vein surgeon, she would have more than likely had her normal leg veins treated (by stripping, laser, radiofrequency or foam sclerotherapy).

Using The Whiteley Protocol, our patients have a scan that identifies exactly where the vein come from - and we don't make any assumptions. Hence most of our scans take some 40 minutes or more (unlike most venous scans that are rattled off in 10 minutes or so - missing more difficult patterns like this).


Varicose veins down the backs of both legs - however scan showed the underlying causes was from Pelvic Veins only. Surgery to the leg varicose veins (Stripping, Laser, Radiofrequency etc) would NOT have worked.
The successful treatment of women with this sort of pelvic venous problem starts off by identifying it.

Pelvic vein problems almost always occur in women who have had at least on baby by normal vaginal delivery. Very occasionally the problem can be found in women who have had caesarian sections - and very rarely in women who have not had childbirth, or in men.

Visible veins on the upper inner thigh, next to the vulva, shows that pelvic veins are probably involved.
One of the "tell-tale" signs are women who have veins at the top and inner side of their thighs, next to their vulva (para-vulval veins) as above.

A pelvic duplex ultrasound scan performed by one of our experts then shows which veins are involved, directing treatment by X-ray, through a pin-hole only.

Once the pelvic veins are treated, the bulging veins on the legs can then be treated, knowing that the chance of them coming back again is minimal.

However, if a woman with this problem had undergone surgery using normal techniques (such as stripping, laser of radiofrequency) the veins would return very soon after treatment, as the underlying pelvic veins would have been missed. Unfortunaltely, this is what usually happens and is one of the reasons that so many women get their veins back again after treatment elsewhere.

For more information please see: www.vulval-varicose-veins.co.uk

New Clinical Grading for Varicose Veins of Vulva

Varicose veins of the vulva and vagina are thought to affect somewhere between 100,000 and 500,000 women in the UK, and countless more in the USA, Europe and the rest of the world.

The usual advice given to women with this problem is that "nothing can be done about it" or to wear tight supportive underwear.

However developments over the last decade at The Whiteley Clinic have shown that this condition can be treated with a combination of embolisation of the pelvic veins causing the problem and then foam sclerotherapy of the veins themselves.

In order to choose the right treatments, a grading system is needed to know how severe the veins are. The Whiteley Clinic grading system for varicose veins of the vulva has therefore was introduced in 2011 and has been recently published (2012).



Description
Frequency seen at present
Grade 0
Normal – no varicosities nor venous reflux in vulva
Usual
Grade 1
No visible varicosities in vulva, but ultrasound proven reflux in vulval veins usually with para-vulval varicose veins seen on inner thigh
Common – 1 in 7 females presenting with leg varicose veins (1 in 5 of those post vaginal delivery)
Grade 2
Visible varicosities seen through mucosa of inner labia and lower vagina and ultrasound proven reflux in vulval veins.
Uncommon
Grade 3
Isolated varicosities seen on standing through skin of outer labia majora without a distortion of the general anatomy of the area
Very uncommon
Grade 4
Extensive varicosities of the labia, distorting skin and distorting the gross anatomy of the area on standing
Rare

If you want to see more about this scale, it was first published in:

The treatment of varicose veins of the vulva and vagina. by MS Whiteley
In: Greenhalgh RM (Ed.) Vascular and Endovascular Controversies Update. London Biba Publishing, 2012 p. 666-670


For more information about varicose veins of the vagina or vulva see: www.vulval-varicose-veins.co.uk

Wednesday 18 April 2012

Barrie Price wins debate about perforator veins

Mr Barrie Price MS MD FRCS FCPhleb
Consultant Vein Surgeon and Fellow of The College of Phlebology
(www.collegeofphlebology.com)

On Tuesday this week, Mr Barrie Price of The Whiteley Cinic, won his debate at a major international medical conference.

The Charing Cross symposium is the biggest vascular conference in the UK - and one of the major Vascular events each year in the world.

The debate was between Professor Charles McCollum and Barrie Price. Professor McCollum was arguing for the popular assertion that below knee perforating veins do not need to be treated, and treating them is pointless.

Barrie Price spoke engagingly and brilliantly explaining his own experience, The Whiteley Clinic research and also the mechanism of action of perforators as outlined in The College of Phlebology book "Understanding Venous Reflux - The Cause of Varicose Veins and Venous Leg Ulcers".

The debate became quite heated as it became clear that Barrie Price's assertion that these perforating veins are very important in varicose veins, venous eczema and the formation of venous eczema - and that the treatment of these perforating veins is actually essential. Indeed the failure of most venous surgeons to do so is one of the major reasons that varicose veins keep coming back again and that patients with venous leg ulcers spend years in bandages rather than being cured by surgery.

When the audience was asked to vote, it came a a huge surprise to traditional vascular surgeons (who generally do not treat perforators) that 2/3rds of the audience voted for Barrie Price and his arguments.

This year, both Barrie Price and Mark Whiteley were invited to speak and write chapters in the Charing Cross book (see previous blog post). In addition, Judy Holdstock and Charmain Harrison from The Whiteley Clinic were asked to teach on The Office Based Vein Course at the same meeting.

Monday 16 April 2012

3 Chapters in Charing Cross Vascular Text book

Mark Whiteley and Barrie Price from
The Whiteley Clinic wrote 3 of the chapters
The book "Vascular and Endovascular Controversies Update" has been released at the Charing Cross International meeting that is currently underway in London.

Mark Whiteley and Barrie Price of The Whiteley Clinic have written 3 of the chapters:
  • Perforating Veins: I prefer radiofrequency and laser - pages 583-588
    M S Whiteley
  • Debate: Treating calf perforators is pointless - Against the motion - pages 602 - 608
    B A Price
  • The treatment of varicose veins of the vulva and vagina - pages 666 - 670
    M S Whiteley
In his chapter on varicose veins of the vulva and vagina, Mark Whiteley announces for the first time:
  1. The observation that haemorrhoids (piles) arise from pelvic vein reflux, making them amenable to treatment by vein techniques
  2. The Whiteley Clinic grading system for vulval venous reflux

Sunday 15 April 2012

Vaginal, vulval and perforator vein treatments


Surgeons Mark Whiteley and Barrie Price, and vascular technologists  Judy Holdstock and Charmaine Harrison - all from The Whiteley Clinic - will be teaching at the Charing Cross Office-Based Vein Practice course tomorrow.

Along with Dr Tony Lopez of The Imaging Clinic, Mark Whiteley and his team will be sharing their expertise in the diagnosis an treatment of:

  • Varicose veins of the vagina
  • Varicose veins of the vulva
  • Incompetent perforating veins
Mark Whiteley and Barrie Price have also been invited to lecture on these subjects on Tuesday in the main Charing Cross meeting.

Mark Whiteley will be lecturing on:
  • Perforating Veins - The place of radiofrequency and laser
and:
  • Vulval disease treated by coil embolisation
Barrie Price will be heading the debate explaining the benefits of treating perforator vein reflux.

Saturday 14 April 2012

1 year of venous eczema being misdiagnosed as cellulitis

Venous Eczema of left ankle -
heading for venous leg ulcer.
Incorrectly treated as cellulitis
for a year
Venous Eczema of same left
ankle -
Incorrectly treated as cellulitis
for a year
This patient came to The Whiteley Clinic for a second opinion recently, unhappy that his "cellulitis" wasn't improving.

The man had had varicose veins for years, clearly seen in the photographs.

Last year, when his ankles started to swell and he started getting red patches around his ankles, especially on the left, he went to his family doctor who told him that he had "cellulitis" - and infection of the skin.

He was was treated over last summer and autumn with antibiotics - 8 weeks in total - and not surprisingly had no effect from these.

He was referred to a consultant dermatologist who gave him steroid cream - which once again made no difference (as we would expect).

Eventually the patient themselves heard about The Whiteley Clinic and referred himself.

Duplex ultrasound scanning at The Whiteley Clinic showed that he has venous reflux (varicose veins) causing swelling of the ankles (oedema) and skin damage. The veins will be easy to treat by The Whiteley Protocol under local anaesthetic.

When the ankles swell due to varicose veins or hidden varicose veins, or there is skin damage from this cause, then there is a high risk of the patient going on to develop venous leg ulcers.

Treatment with antibiotics or steroid creams do not change this. All such patients should be sent to a specialist vein clinic and have venous duplex ultrasound scan performed by a specialist.

Treatment of the underlying varicose veins (or hidden varicose veins) is performed under a local anaesthetic through tiny pin-holes and not only cures the venous eczema - but also stops any further deterioration, preventing leg ulcers.

For more information see: www.venouseczema.co.uk 


Tuesday 3 April 2012

"Best for Legs" - Tatler Guide

See Tatler - Beauty and Cosmetic Surgery Guide 2012 - May 2012
I am absolutely thrilled to be included in the Tatler "Beauty and Cosmetic Surgery Guide - 2012".

This guide surveys the most sought out Doctors in the UK and is published in May.

This year's gide has just hit the shops and is included when you buy Tatler.

You can also buy Tatler and the Guides online at:

http://www.tatler.com/ 

College of Phlebology launched

The College of Phlebology at www.CollegeofPhlebology.com

The College of Phlebology has now been launched.

This portal about veins and venous conditions allows the public to find specialists to treat anything from Thread Veins, through Varicose Veins to venous Leg Ulcers.

Specialists who join are either:
  • MCPhleb - which means they treat thread veins only
  • FCPhleb - which means they treat varicose veins and other venous conditions also
For the specialists who join, there are teaching videos, forums, news and "Ask an Expert" sections behind the password protected area.

The aim of The College of Phlebology is to raise the profile of vein problems and varicose vein and other vein treatments, to try to encourage health care specialists to specialise in veins themselves or to refer to appropriately trained people.

It also aims to support those healthcare professionals who want to become Phlebologists and have a major interest in treating veins.

Finally, the College of Phlebology aims to provide the public with information, so that they don't end up having out of date treatments that are less effective or have worse results.

www.CollegeofPhlebology.com