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

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.

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

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.

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 



"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

Bad medical advice on Embarrassing Bodies

Screen shot of Embarrassing bodies, screened 9pm 26th March 2012.
Venous Eczema "treated" with steroid cream - but patient told it is due ot venous circulation and not offered a cure!!
See www.venouseczema.co.uk 

On Embarrassing Bodies - screened last night at 9pm - a patient was seen by one of the GP's with venous eczema of his leg.

He was correctly told that he had venous eczema and that this was due to "poor circulation" of his venous system - a simplified explanation of Venous Reflux or "hidden varicose veins".

However, despite the correct diagnosis and also the correct understanding of the cause being the underlying veins, the GP then suggested a treatment to help the skin (steroid cream) ..... but did absolutely nothing to correct the underlying "poor venous circulation" (the Venous Reflux or "hidden varicose veins").

As such, this patient will get a temporary improvement of the eczema, which will all come back again, and nothing to help the Venous Reflux as his leg deteriorates towards a venous leg ulcer.

The correct treatment would have been to refer the patient for a specialised venous duplex ultrasound scan, to find out which veins are causing the problem, and then to treat them under local anaesthetic by the most appropriate technique using The Whiteley Protocol.    

This would have resulted in the venous eczema disappearing, the brown stains starting to fade, and the pateint's leg would be less swollen and would continue to deteriorate.

As it has been left, this poor man my have a temporary relief from his eczema, but his leg will continue to deteriorate, get more brown and swollen ans eventually ulcerate.

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

To understand Venous Reflux and how it causes venous eczema and leg ulcers see "Understanding Venous Reflux"

Veinscreening.co.uk quoted in Sunday Express Magazine

Today, Mark Whiteley was quoted in the "S" Sunday Express Magazine ("Alive and Kicking" S Magazine, 2 5th March 2012, page 39).

This excellent article ran through several conditions affecting the legs and their treatment - including the need for a scan if you have leg thread veins to identify any "hidden varicose veins" underlying and causing the thread veins.

Mark Whiteley and www.thewhiteleyclinic.co.uk were quoted in the section on varicose veins, and the website http://www.veinsscreening.co.uk was recommended for people to go to, to find out if they need help from a specialist.

The Skin Reference Guide

A simple to use reference guide to common skin lesions and skin lumps and bumps.

It also has useful tips on treatments for each condition.

http://www.skinreferenceguide.co.uk/

Flying over Brighton with Phoenix Helicopters

This video was taken during one of my training flights with the Phoenix Helicopter Academy (http://www.phoenixhelicopters.co.uk/) earlier this year in an R44.

Phoenix does traing flights if you want to learn - or pleasure flights if you just want to sit back and have a great experience!!!

Whichever, it is the best feeling in the world :-)

Video of Toast of Surrey Awards

First time I've seen one of my own impromptu speeches!!

Mark Whiteley - Business Personality of the Year 2012

Last night, at the Yvonne Arnaud Theatre in Guildford, Mark Whiteley was awarded the Toast of Surrey "Business Personality of the Year - 2012".

The event, run by the Surrey Advertiser, is now in it's fourth year.

A full report of the event will be in next week's Surrey Advertiser newspaper.

Very good report from CQC on Whiteley Clinic

Congratulations to all members of The Whiteley Clinic on an excellent report from the CQC.

http://www.cqc.org.uk/sites/default/files/media/reports/1-101725934_The_Whiteley_Clinic_Limited_1-118339155_The_Whiteley_Clinic_Limited_20120220.pdf

Reflexology by Jade Davidson at The Whiteley Clinic, London

We are delighted to announce a new service for our London patients, starting March this year (2012).

The Whiteley Clinic specialises in providing the very latest local anaesthetic surgery for varicose veins and venous disease (such as leg ulcers, venous eczema, phlebitis etc). However a great many patients find the whole idea of surgery (even the latest keyhole surgery) quite stressful. 

To help reduce this stress and anxiety, we are very pleased to be able to offer the expertise of Jade Davidson, reflexologist from "Rosey Feet".

In conjunction with Mark Whiteley, Jade has developed a range of packages to help Whiteley Clinic patients through their local anaesthetic procedure, to relax after immediately after the operation and to sleep well the night before the operation.  

As this is a new service, it will only be available to our London patients in the first instance. If you would like to know more about this service, please download our leaflet by clicking below, or contact Jade directly at jade@roseyfeet.co.uk :

Click here to download information sheet and price list

Tatler March 2012

There was a lovely article in the current edition of Tatler (March 2012, p202) entitled "Tatler Treatments".

Amonst several excellent sections on the page, Mark Whiteley was featured for the treatment of excessive sweating.

The article is well worth the read.

http://www.tatler.com/magazine

Why not to use laser for Leg Thread Veins

I saw this young lady today who had been to a cosmetic clinic for removal of leg thread veins.

She had not been offered a Doppler or duplex ultrasound, and so the clinic had missed her underlying venous reflux ("hidden varicose veins") which contributed to her thread veins.

In addition, she had been treated with external Laser to the skin, which had failed to get rid of the majority of the thread veins, and had left her after healing for several months, with these very noticeable white scars on the skin.

Although external laser treatment is very good for thread veins of the face, which is above the heart and therefore there are no gravity problems associated with the thread veins and the facial skin is very resistant to heat as it is always exposed, the reverse is found for thread veins of the legs.

Thread veins of the legs are affected by gravity, especially if associated with underlying "hidden" varicose veins, and so it is essential to have a venous duplex ultrasound before any treatment is planned.



Once treatment is planned and the underlying veins are fixed, the thread veins of the legs should be treated with microsclerotherapy injections and NOT external laser, which can easily burn and scar the skin of the leg, which is far more sensitive to radiation and laser.

see: www.thread-veins.co.uk

"Shaving Foam" for Varicose Veins

In today's Times is an article on page 37 entitled ""Shaving Foam" treatment of varicose veins passes test".

Although a very good piece to attract interest and funding, the article states that the treatment of varicose veins "usually" consists of "stripping them out" under "general anaesthetic".

Well as anyone who has been following our work at The Whiteley Clinic will know, we were presenting prize winning research in 2005 showing such treatment to be inadequate (www.veinstripping.co.uk) and our work was even featured in the Mail in December 2010 in a feature entitled:

"Ladies, stop stripping .... (your varicose veins that is!)

 http://www.dailymail.co.uk/health/article-1335718/Ladies-stop-stripping---varicose-veins--A-leading-vascular-surgeon-says-outdated-procedure-replaced-laser-treatment.html

Therefore although Foam is a good procedure in minor cosmetic veins, or in some recurrent veins, it is only really useful when used in CONJUNCTION with other endovenous techniques such as endovenous laser ablation (EVLA), radiofrequency ablation (RFA), coil embolisation etc.

Thus, as the research is fairly clear that in large varicose veins where the main vei to be treated is larger than 6 mm the results from foam sclerotherapy are far inferior in the medium to long term compared to these other endovenous techniques, the Times article should be considered with some caution.

Foam Sclerotherapy is an excellent treatment when used in combination with other endovenous vein treatments, but is rarely the optimal treatment when used alone.

Whiteley Clinic Research presented in Paris

This weekend, two members of The Whiteley Clinic presented their research at an international confernece in Paris.

Sophie Strong (pictured above) presented her work on the use of Laser Sweat Ablation (LSA) to treat Bromhidrosis (body odour of the under-arms - www.bromhidrosis.co.uk).

Vicki Smith, director of Absolute Aesthetics (a division of The Whiteley Clinic) presented her echnique and results for treating Xanthelasma (www.xanthelasma.co.uk).

Whiteley Clinic research being presented at IMCAS in Paris

The Whiteley Clinic and Absolute Aesthetics researchers are in Paris at the International Master Course on Aging Skin (IMCAS).

This year we have 6 research papers being presented:

Oral presentations:

• Early report on effectiveness of Laser Sweat Ablation (LSA) to treat Bromhidrosis - Sophie Strong
• Removal of Xanthelasma using advanced electrolysis - Victoria Smith

In addition, the team has 4 e-papers being presented:

• The removal of Dermatosis Papulosa Nigra using advanced electrolysis - Victoria Smith
• Optimising laser technique in Laser Sweat Ablation (LSA) - An in-vitro study using porcine skin - Sophie Strong, Mark Whiteley
• Endoscopic Laser Sweat Ablation (ELSA) - a new technique for the treatment of axillary hyperhidrosis and bromhidrosis - Mark Whiteley
• 2.5 year results of Laser Sweat Ablation (LSA) for axillary hyperhidrosis - Mark Whiteley

 

Last chance to vote



Last chance to vote - voting closes on 25th Jan 2012.

You can vote online through Facebook:

www.facebook.com/toastofsurrey

Venous Eczema cured with EVLA

I have just seen a 76 year old lady who came to see me in July last year with red itchy ankles and a little ankle swelling.

She had been to her GP who had been treating her with steroid cream and support stockings.

Although the steroid cream made the legs itch less, and the support stocking made the legs feel better when they were being worn, the red marks slowly worsened and spread.

The patient saw http://www.venouseczema.co.uk and thought she might have varicose eczema (or venous eczema).

She came to The Whiteley Clinic and had a duplex ultrasound scan in July 2011.

This scan showed her problem was indeed due to hidden varicose veins (or "Venous incompetence") which couldn't be seen on the surface.

In early December 2011 she had EVLA (Endovenous Laser Ablation) of the hidden varicose veins.

Today - 6 weeks after the treatment - the legs are back to normal.

There is no swelling at the ankles, the skin is normal colour with no itching. She has not used steroid cream nor support stockings since.

We see such cures regularly. When people have ankle discolouration, swelling or itching, they should have a duplex scan in a specialist clinic to check for curable hidden varicose veins before being consigned to a lifetime of steroid creams and support stockings that will help the symptoms but not cure the problem.

Mark Whiteley interviewed by US domain expert

 

Read the interview with Mark Whiteley about his internet strategy on:

http://fragerfactor.blogspot.com/2012/01/seller-schilling-meet-buyer-whiteley.html

Sapheon glue for Varicose Veins

At lunchtime today, I met Dr Rod Raabe, consultant radiologist and inventor of Sapheon "superglue" for the treatment of varicose veins.

Those of you who read my blog or websites will know that I have had some reservations about this and outline some of the questions that I would need answering before I would consider using it.

I must say that Dr Raabe is one of the most informed doctors I've met in the venous world with regards the mechanism of closing veins, and he was able to answer every single one of my questions.

Having chatted to him, I am convinced that the Sapheon system is likely to become a major technique in the local anaesthetic treatment of varicose veins.

Previously, my concerns had been that "gluing" the vein together from the inside might leave the wall intact, allowing the vein to reopen again in the future.

However research quoted by Dr Raabe answer this question fully. He was able to explain that the glue seems to cause the inside layer of the vein to heal across the vein lumen, effectively stopping the natural repair of the vein which would be along the vein.

Just as importantly, he told me that the ultrasound appearances of the vein after the operation seems to suggest that the vein does indeed fade away, suggesting that the body starts "ingesting" the vein after a few months.

This all raises my hopes that we will have another new system that will be successful in the long-term treating varicose veins endovenously and under local anaesthetic.

If this is the case, the Sapheon system will have major advantages as it does not use heat and therefore will not need injection of tumescent anaesthesia (local anaesthesia) along the length of the vein. This will make the procedure more comfortable and quicker.

As with all new techniques, research will eventually show us the place of Sapheon in the pantheon of new vein techniques.

However, basic science can often show us which ones are more likely to be successful and which ones are unlikely to be successful. Having spoken to Dr Raabe today I truly think Sapheon is likely to be a successful treatment, with results and reputation based on excellent basic research.

My only upset is that now I am going to have to rewrite the ending to my latest book on veins!!

Toast of Surrey - Finalists announced

Finalists announced in all categories and votes requested for "Business Personality" of the year.

Link: http://www.getsurrey.co.uk/business/s/2106431_toast_of_surrey_2012_finalists_revealed

Your vote is needed!!!

We are thrilled that Mark Whiteley has been shortlisted for "Business Personality of the Year" in the Toast of Surrey Awards. This was announced in the Surrey Advertiser today (13 Jan 2012).

To vote for Mark, please e-mail:

surreymarketing@trinitysouth.co.uk

and state you are voting for Mark Whiteley.

 

We are also delighted that The Whiteley Clinic has also been nominated for "Best Business with a turnover up to £5 million".

There are three companies in this category. With our continued expansion, development of new and better procedures for our patients, and with both doctors and patients travelling from all around the world to Guildford to either train or have our procedures, we hope that we will show well in the final.

Thank you all for your support.

Daily Mail Article - Varicose veins? Forget lasers and try a quick squirt of foam

On 10th January 2012, The Daily Mail in the UK ran an article:

"Varicose Veins? Forget lasers and try a quick squirt of foam".

This article featured a patient who had had been treated with Foam Sclerotherapy to her Great Saphenous Vein (GSV) - the cause of her varicose veins. The "General and Vascular Surgeon" who performed the procedure explained that they had done a study comparing laser (EVLA - endovenous laser ablation) with Foam Sclerotherapy.

He is quoted as say that the Foam Sclerotherapy is cheaper and just under half needed a second treatment as the first hadn't worked properly.

However, those of us who spend all of our time treating veins know the research that shows that in veins over 6 mm diameter, after 3 years most of the veins have re-opened again, causing the previous problems (varicose veins, skin damage, leg ulcers etc) to return.

With EVLA (laser) - if done properly as in The Whiteley Protocol - the closure of the treated vein in 99.9% at first procedure AND is PERMANENT.

Therefore the claims that Foam Sclerotherapy is cheaper and less painful in these large varicose veins can only be made because the study hasn't checked the results at 3 years and 5 years.

Many studies on Foam Sclerotherapy in these large veins have already been done, and so those of us who want the best long term results for our patients do not use Foam Sclerotherapy in vein larger than 3 mm.

It is always a concern to us vein specialists who are sought out by patients who have had multiple vein procedures that have failed in the medium to long term, to see articles like this that encourage people to have a procedure for a short term benefit when there is very good research to show it is not a good idea in the long term.

Foam Sclerotherapy does indeed have a place in the treatment for varicose veins, but as an additional procedure to laser (EVLA) NOT to replace it.

Mark Whiteley in The Times Newspaper

The Times Newspaper ran an article about Mark Whiteley of The Whiteley Clinic in their "Expert Advice" section, on Monday 3rd January 2012

The article was called "How to look and feel your best for 2012".

Under the section called "Get rid of broken veins", Sarah Vine detailed her experience of being treated by Mark Whiteley at The Whiteley Clinic in London.

She initially had duplex ultrasound scanning to check for the underlying cause of her "broken veins" or thread veins.

She was then treated using ultrasound guided Foam Sclerotherapy and Microsclerotherapy.

For more information, follow the link: http://www.thetimes.co.uk/tto/health/advice/article3273995.ece

College of Phlebology

The new College of Phlebology Blog has been launched today in the countdown to the arrival of the new College of Phlebology web portal about veins.

http://collegeofphlebology.blogspot.com/

November Pre-Med Course Graduates - Wednesday Group

The Wednesday Group of the November 2011 Pre-Medicine Taster Group graduated this week (pictured above with Mark Whiteley and Barrie Price).

The Pre-Medicine Taster Course is run at The Clinical Exchange in Guildford to help sixth form college students an insight into a medical career.

The pre-medicine taster course is run over 8 weeks, one evening per weeks, giving school and college students the opportunity to find out more about a career in medicine including:

• Ultrasound practicals
• Suturing (Stitching)
• Lectures on different aspect of medicine, surgery, radiology, general practice
• Practice on taking a patient history
• Injecting and taking blood
• Mock medical school interviews

and many other theoretical and practical sections.

Each student is issued with a certificate of attendance to add to their experience and personal statement for their application to medical school


For more information: http://www.theclinicalexchange.com/courses/category/premed-taster-course

November Pre-Med Course Graduates - Tuesday Group

The Tuesday Group successfully completed their Pre-Medicine taster course at The Clinical Exchange last night - Pictured above with Mr Mark Whiteley.

The pre-medicine taster course is run over 8 weeks, one evening per weeks, giving school and college students the opportunity to find out more about a career in medicine including:

• Ultrasound practicals
• Suturing (Stitching)
• Lectures on different aspect of medicine, surgery, radiology, general practice
• Practice on taking a patient history
• Injecting and taking blood
• Mock medical school interviews

and many other theoretical and practical sections.

Each student is issued with a certificate of attendance to add to their experience and personal statement for their application to medical school

For more information: http://www.theclinicalexchange.com/courses/category/premed-taster-course

Excellent business performance in last year by The Whiteley Clinic

The latest analysis by Plimsoll (Fourth Edition Nov 2011) of UK Private Hospitals and Clinics has shown some excellent news for The Whiteley Clinic - including:

- The financial strength of The Whiteley Clinic is "well above the industry average"
- The Whiteley Clinic was ranked 15th fastest growing in the last year
- The Whiteley Clinic was in the first 25 companies that were listed as a "Best Trading Partner"
- The Whiteley Clinic a also in the top 30 of the "Fastest Growing Company" category

We believe that:
- striving for excellence in our patient care
- keeping at the forefront of research into the areas of venous disease and associated medical areas
- using all of our discoveries to benefit our patients
- sharing our knowledge and techniques with other doctors and nurses through our courses, books and articles

.. is the basis of our current position and should help us continue to grow and help even more people, both patients and professionals alike.

Radiofrequency Ablation of Veins and DVT - Answer to You Tube Comment

The following question was posed on You Tube on our video of RFiTT ablation of Varicose Veins (http://www.youtube.com/watch?v=fUQsaY1oY2M). As there is a limit to characters there, we have posted the full answer here:

Question:

What are the chances of developing DVT after closing the GSV with RFA procedure? What would be the best way to avoid developing DVT after RFA on the left GSV? Will there be a chance the the vein can reopen within a few weeks after the treatmenet?


Answer:

Thank you for your question.

If we look at all forms of deep vein thrombosis after all forms of radiofrequency ablation, over the last 12 years, then in our experience the risk is 0.7%, and this is in our published research which you can find via the link: http://www.ncbi.nlm.nih.gov/pubmed/20655773 (the full reference is at the bottom of this comment).

However that is a gross over-estimation compared to our current results under local anaesthetic using the RFiTT device. When we looked at our results in this publication, we were looking at mainly the VNUS Closure catheters, which we do not use more recommend any more, as we find big advantages with RFiTT radiofrequency ablation. For of 17 patients did not have a true DVT but only the minor EHIT. Of the others, the majority of them had other procedures performed including stripping of the small saphenous vein which we do not do any more as these can easily be closed with RFiTT, and also almost all of the DVT is would in patients who had general anaesthetic wear as nowadays we only perform local anaesthetic unless the patient insists.

It is well recognised that general anaesthetic is associated with a higher risk of deep vein thrombosis as the patient does not move so much and also you have to starve before a general anaesthetic, making you dehydrated are more likely to get a DVT. Since using RFiTT for our radiofrequency ablation some two years ago, and since performing all of our procedures under local anaesthetic since 2005, we have not had a major deep-vein thrombosis due to the radiofrequency ablation since. Therefore the risks are very low although of course it is possible that someone somewhere will get one, as people get DVT's occasionally even if they're not having any procedure!

With regards reducing the risks for your left GSV treatment:

- 1 - Have it done under Local Anaesthetic so you are not starved first and mobilising immediately
- 2 - Have sub cutaneous Heparin to cover the procedure (we give one dose during the procedure that lasts 24 hours)
- 3 - Make sure the technique used causes fibrosis of the vein wall - not thrombus formation in a semi-treated vein

Turning to your question about the risk of the vein opening up again a few weeks after treatment, this is virtually impossible provided the correct treatment is performed. When the first RFiTT device was produced, the recommendation was to use a very fast pullback which inadequately treated the vein. Reopening of the vein was very common after this, mainly due to the vein wall being inadequately treated and thrombus being formed inside the vein lumen. We contacted the company and spent some years explaining to them that their recommended treatments were suboptimal but for some while we were ignored. Fortunately Olympus then took over the RFiTT and we worked closely with them to optimise the treatment.

We started using RFiTT when we performed our own research and showed how to reduce the power and to reduce the pullback time. By doing this we make sure that the vein wall is maximally heated and the chance of reopening or thrombus formation is virtually zero.

This research won a prize in an international meeting in Milan a year ago and has been presented in the UK at a major vein meeting. Unfortunately not everybody uses our technique and so having RFiTT or any radiofrequency ablation really depends not only on having the optimal equipment but also ensuring that the person using it is experienced and is using the correct and optimal treatment settings.

We have recently audited our results and have 100% success at closing the GSV at one year.

We have submitted our research to Phlebology journal, but have met many obstacles in getting it published due to the peer review process. We sincerely hope that it will be published soon so that all doctors will be able to use our settings and will be able to give their patients the advantages that we can due to our research.

Reference:

Deep vein thrombosis (DVT) after venous thermoablation techniques: rates of endovenous heat-induced thrombosis (EHIT) and classical DVT after radiofrequency and endovenous laser ablation in a single centre. Eur J Vasc Endovasc Surg. 2010 Oct;40(4):521-7. Epub 2010 Jul 23.

Marsh P, Price BA , Holdstock J, Harrison C, Whiteley MS.)

Vogue - December 2011

Mark Whiteley is to be included in Vogue, Dec 2011, under "Legs".

Mark is once again called "the Vein Vanisher" and his new London Clinic - The London Leg Clinic - is quoted:

www.londonlegclinic.co.uk

Lymphoedema of leg treated by MLD at The Whiteley Clinic

The experience of a patient with severe swelling of the leg due to lympoedema treated by Sarah Moh at The Whiteley Clinic using MLD, laser and bandaging.

Dr Kahina Betroune joins The Whiteley Clinic

We are delighted to welcome Dr Kahina Betroune, Phlebologist, to the vein specialists at The Whiteley Clinic.

"Kahina is a French Phlebologist who qualified in Paris from the University Paris Descartes. She gained experience in several hospitals and private practices throughout France and worked alongside pioneers in Phlebology and Vascular Medicine.

She joined The Whiteley Clinic, a forward-looking research based clinic, in July 2011 to train in and adopt the most up to date techniques of the Whiteley Protocol. Her broad specialist experience including both diagnostic and treatment provides additional perspectives which complement the clinic’s ethos.

Kahina has experience in teaching and has lectured at several congresses with her research published in international journals.

Being fluent in both Arabic and French, Kahina adds an international dimension which has already proved a great asset in understanding the needs and engaging with a number of patients from abroad.

Kahina is passionate about the arts in general (opera, painting, theatre…), being French she enjoys gastronomy and exploring new horizons - not necessarily in that particular order!"

Kahina joins a grow number of venous specialists at The Whiteley Clinic - for more information please see:
www.TheWhiteleyClinic.co.uk



Experience of varicose veins treatment at The Whiteley Clinic, London Clinic

Comment on Whiteley Clinic treatment by Mr AC - 34 Years old male:

"The central London pre-treatment consultation and scan was very efficient and convenient. I was reassured by the clear explanation of the proposed treatment method and why it achieves better outcomes than the commonly used vein stripping procedure.

The treatment day was as efficient - literally a walk in and walk out service. I couldn't believe that, after the operation, I could just walk to the station and catch the tube home without a shred of discomfort. The clinic was very comfortable and the care very considerate.

The operation itself was quick, without any pain, and I was very well looked after by an excellent consultant anaesthetist and other medical staff. I didn't require any pain killers at all after the procedure, and had no discomfort.

I am absolutely amazed at the results - the varicose veins have completely disappeared, but for me, more importantly, the pain has completely gone. I can stand for hours with no pain, and the days of long dull aches have gone. Thanks for fixing me up!

With best wishes to you and many thanks - a special thanks too to the vascular technologist - I had a scan previously (when booked in with the NHS to have the vein stripped...) and it was really uncomfortable; your guy was superb."

Veins book available on Amazon

This text book, written by Mark Whiteley explains how veins work, and how they go wrong to cause thread veins, varicose veins and leg ulcers.

It is an essential text for all doctors, nurses and therapists who treat veins - and all doctors and nurses who advise patients (such as General Practitioners or Family Doctors).

It has bee written in an easy to follow style with 53 diagrams so that anyone with an interest in vein or venous disease can understand it - even if not medically trained.



Understanding Venous Reflux - The Cause of Varicose Veins and Venous Leg Ulcers is now available as a paperback or on the Kindle as an e-book.

https://www.amazon.co.uk/Understanding-Venous-Reflux-Varicose-Ulcers/dp/1908586001/ref=sr_1_sc_1?ie=UTF8&qid=1319632814&sr=8-1-spell

Minimally invasive vein treatment course - Opinion received today

"I would like to thank you for the great course that we had with you. We have learned a lot about all minimally invasive venous procedures (from A to Z) including endovenous ablation (laser/ RF), phlebectomies, microsclerotherapy and foam sclerotherapy. I would like to inform you that in the last 5 months (since we had the course) our skills in all venous procedures were dramatically improved and our patients were very satisfied with the results.


We learned not only techniques but also exact indications for each procedure for different patients significantly.

After following your strategies, we were able to boost our practice and attract more patients in the last few months. I strongly recommend this course for every person involved or just started or willing to learn about venous diseases and chronic venous insufficiency.

Thank you again Mr. Whiteley and all your colleagues and staff for all what you did for us and looking forward for future visits."

For more information about The Whiteley Clinic minimally invasive vein courses run through The Clinical Exchange, please see www.theclinicalexchange.com under "courses".

Mark Whiteley speaking at Professional Beauty North this Sunday, 17th October 2011

Mark Whiteley is a guest speaker at Professional Beauty North, on Sunday 17th October 2011.

He will be giving a 45 minute talk on "Overview of invasive and non-invasive vein treatments", at the Medical Aesthetics seminar of the meeting.

Mark will be happy to answer any questions after his talk.

Link: http://www.professionalbeauty.co.uk/site/Default.aspx?id=ac7e5254-89db-44b5-a47a-c19665b8de20

Sapheon (CyanoAcrylate Glue) to close varicose veins - questions need answering

The Sapheon system for treating varicose veins will soon be trialled in Europe.

Sapheon is basically "super-glue" that is put up inside the vein to be treated, using a long thin tube (called a catheter).

This tube can be positioned under ultrasound control making sure it is positioned in the correct position, and then the glue (CyanoAcrylate) injected.

The advantages of this system are that like Endovenous Laser Ablation (EVLA) and Radiofrequency Ablation (RFA) it is put up inside the vein under ultrasound control - so it is done without general anaesthetic through pin-holes only.

A supposed advantage is that "tumescent" anaesthetic doesn't have to be injected around the vein (like the claims by Clarivein - see earlier in this blog) as there is no heat. However whether this is an advantage to the patient or just to the fact that this gets around a US Patent on using tumescence held by another company is less clear!

However before we all rush to use this new technique, there are several questions that need to be answered.

Although the company claims that it closes the vein and causes fibrosis (which is good and what we want) the model on pig veins that is quoted seems to show fibrosis INSIDE the vein - NOT of the whole thickness of the vein wall.

We already know that sclerotherapy when used in the the big "truncal" veins causes fibrosis inside the vein - but not through the whole vein wall, and the failure rate over the first couple of years in unacceptably high.

Therefore, just as our councerns with the medium to long term results from Clarivein for the same reason, we would worry that Sapheon will show good "closure" of the treated veins in the first few months by bunging up the vein with a combination of clot and fibrous tissue - only to have an increasing number of failures over the first few years as the living vein wall always healing and the vein to re-open.

Hopefully for Sapheon they will be able to show this is not the case - but on our current understanding of how venous occlusion works and our own research, we doubt that the results will be anywhere as good as the 100% closure and atrophy of veins we are seeing at 5 - 10 years post EVLA and RFA when used under The Whiteley Protocol(TM)

Easy Living Magazine - November 2011

There is an excellent article coming out in Easy Living Magazine, November issue (pages 140 - 143).

Kate Shapland has written a very informative article on the Varicose Veins - and outlined the best and worst treatments.

Mark Whiteley is quoted several times - and one of The Whiteley Clinic patients who had pelvic vein embolisation is featured.

See: Easy Living Magazine, November 2011, Page 410-413

Mark Whiteley invited to give 2 talks at Charing Cross Symposium April 2012

Mark Whiteley has been invited to give 2 talks at next year's Charing Cross International Symposium.

He will be giving talks on the treatment of incompetent perforator veins and the treatment of vulval and pelvic varicose veins.

Mr Barrie Price, also of The Whiteley Clinic will be part of the debate on treating perforating veins.

To see the program and to register, please follow the link:

http://www.cxvascular.com/cx-main-programme

Understanding Venous Reflux - Available on The Kindle at Amazon

Understanding Venous Reflux - The Cause of Varicose Veins and Venous Leg Ulcers is now availble on the Kindle at Amazon:

http://www.amazon.co.uk/Understanding-Venous-Reflux-Varicose-ebook/dp/B005QBFBUC/ref=sr_1_1?s=digital-text&ie=UTF8&qid=1317291106&sr=1-1

Mark Whiteley is a Guest Speaker at Professional Beauty in Dublin this weekend

Mark Whiteley has been invited to be a guest speaker at the Medical Aesthetics Seminar of Professional Beauty, at the RDS in Dublin this weekend

Mark will be presenting a lecture entitled:  "Overview of invasive and non-invasive vein treatments".

For more information about the meeting please see:

http://www.professionalbeauty.co.uk/site/Default.aspx?id=53173c2a-b1da-4378-9efa-9fc3fd183cc1